SAN DIEGO — Ocular and periocular melanoma will occur in fewer than 2,900 people in the United States in 2005, Geva Mannor, M.D., said at a melanoma update sponsored by the Scripps Clinic.
Despite the rare prevalence of these lesions, it's important to understand who is at risk and when to refer to an eye specialist, said Dr. Mannor, an ophthalmologist with the La Jolla, Calif.-based Scripps Clinic.
First, any patient with atypical, familial, or unusual nevi; greater than 4 nevi; iris nevi; or a prior history of melanoma should be referred to an ophthalmologist.
Second, patients with prior eye melanoma should undergo an annual skin exam.
Third, patients with prior eye melanoma and greater than 4 atypical moles or nevi, history of early sunburn, or family or prior history of cutaneous melanoma should have more frequent skin exams, “perhaps every 3-6 months,” Dr. Mannor said.
The three main types of ocular and periocular melanoma include the following:
▸Choroidal melanoma. This is the most common form of eye melanoma. There will be an estimated 2,500 cases nationwide in 2005.
“Usually these patients are referred to retina subspecialists within ophthalmology and sometimes even ocular oncologists,” Dr. Mannor said.
Survival can be up to 89% at 5 years and 84% at 15 years, “but with a lot of new technology, we often don't have to remove the eye,” he said.
▸Lid melanoma. There will be fewer than 300 new cases of lid melanoma in 2005. This form is six times as common in whites as in blacks, and is usually in the lower or lateral lid.
Lesions on the myocutaneous lid margin are a poor prognostic sign. Another strong prognostic indicator is Breslow depth: the greater the depth, the worse the prognosis.
▸Conjunctival melanoma. There will be fewer than 70 cases of this form in 2005. Most occur on the conjunctiva behind the eyeball. The rest occur on the eyelid or in both regions. Approximately 75% will arise from primary acquired melanosis with atypia. “If the melanoma is close to the eyeball, it's a good prognosis,” Dr. Mannor commented.
Dermatologists can perform a quick exam of the eye by flipping the upper lid over a cotton swab. To look under the lower eyelid, grasp the lower eyelid and gently pull down on it.