Apt Lecture
Iris melanoma: Features and prognosis in 317 children and adults

Presented as part of the 2011 Leonard Apt Lecture at the 37th Annual Meeting of the American Association for Pediatric Ophthalmology and Strabismus, San Diego, California, March 30-April 3, 2011.
https://doi.org/10.1016/j.jaapos.2011.10.012Get rights and content

Purpose

To evaluate iris melanoma in children versus adults.

Methods

Retrospective, nonrandomized clinical case series including all patients with a clinical diagnosis of iris melanoma managed at the Ocular Oncology Service at Wills Eye Institute over 40 years. Patients were divided into three age categories based on age at presentation: children (≤20 years), mid-adults (21-60 years), and older adults (>60 years). The clinical features, treatments, and outcomes were statistically analyzed based on patient age at presentation. The main outcome measures were melanoma features and related metastasis and death.

Results

Of 8,101 eyes with uveal melanoma, there were 317 (4%) with iris melanoma, including 24 (8%) children (≤20 years), 187 (59%) mid-adults (21-60 years), and 106 (33%) older adults (>60 years). There was no age-related difference in race, sex, tumor quadrant, thickness, pigmentation, associated corectopia, ectropion uveae, hyphema, or extraocular extension. Significant age-related differences were found with mean tumor basal diameter, tapioca appearance, mean intraocular pressure, secondary glaucoma, tumor seeding in angle, and mean number of clock hours of angle seeding. Multivariate analysis of factors predictive of metastasis included extraocular extension and high intraocular pressure. Factors predictive of death included increased tumor thickness and high intraocular pressure. There was no difference in metastasis or death by age group.

Conclusions

Iris melanoma shows significant clinical differences in children versus adults, with smaller tumor size, less tumor seeding in angle, and lower incidence of secondary glaucoma. There was no significant difference in metastasis or death by age group.

Section snippets

Methods

This retrospective, nonrandomized clinical case series included all patients with a clinical diagnosis of iris melanoma managed at the Ocular Oncology Service at Wills Eye Institute between August 25, 1970 and May 1, 2011. Institutional review board approval was obtained for this study. The patients were divided into three age categories based on age at presentation: children (≤20 years), mid-adults (21-60 years), and older adults (>60 years). All patients were examined by one of the senior

Results

Of 317 eyes in 317 patients with iris melanoma, 24 (8%) were in young patients (≤20 years), 187 (59%) in mid-adults (21-60 years), and 106 (33%) in older adults (>60 years). A comparison of the features based on age (children, mid-adults, older adults) was made. The patient demographic data are listed in Table 1. Iris melanoma occurred in 98% of whites and 2% of nonwhites without statistical difference in race, sex, or laterality among age groups.

The clinical features of iris melanoma are

Discussion

According to the Surveillance, Epidemiology, and End Results database, the mean age-adjusted incidence of uveal melanoma in the United States is 5.1 cases per million population.2, 3, 7 The age-specific incidence of uveal melanoma reveals increasing incidence with age (males, females per million population) as follows: 0-4 years (0, 0), 10-14 years (0.2, 0), 20-24 years (0.4, 0.6), 30-34 years (1.7, 1.7), 40-44 years (3.9, 2.4), 50-54 years (10.5, 6.5), 60-64 years (14.9, 11.7), 70-74 years

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  • Cited by (0)

    Financial support: Provided by a donation from Michael, Bruce, and Ellen Ratner, New York, New York (JAS, CLS) and the Eye Tumor Research Foundation, Philadelphia, Pennsylvania (CLS, JAS). Statistical analysis provided by Rishita Nutheti, PhD, Hyderabad, India.

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