Uvea is present posterior to sclera and the cornea and has three parts namely, iris, ciliary body and choroid. Uveal melanoma is referred as the cancer of the parts of eye including the iris choroid and ciliray body. It is the condition in which the tumors arise from the melanocytes residing within the uva responsible for the color of the eye. Though is a rare condition, it is most common type of intraocular malignancy in adults. The uveal melanoma treatment depends on various factors most important being the size of the tumor. This type of melanoma is completely asymptomatic in the initial stages.
On enlargement of tumor with time, certain changes may be observed such as distortion of pupil, decreased visibility due to secondary retinal detachment and blurred vision. Risk factors for this kind of cancer include fair complexion, blue, and green or light colored eyes, and older age. The role of inherited genetic mutation in uveal melanoma is yet unknown. According to the American Cancer Society, about nine of 10 melanomas of the eye develop in the choroid. The society also reports about 2,730 new cases in 2014 of uveal melanoma in the U.S.
The global uveal melanoma market can be segmented based on diagnostic tests, therapy type, location type and geography. Location type can be further classified as iris melanoma, choroid melanoma and ciliary melanoma. Primary treatment involves enucleation i.e. removal of the affected eye. However this has now been replaced by radiation therapies such as plaque brachytherapy in the developed countries. Other types of treatment include external beam proton therapy, transpupillary thermotherapy, surgical resection techniques (transretinal endoresection and trans-scleral partial choroidectomy), gamma knife stereotactic surgery and also combination of these modalities.
For small size tumors, the treatment available includes photocoagulation, photodynamic therapy, and local resection. The selection of appropriate treatment largely depends on the size and location of the tumor; associated ocular findings; the status of the fellow eye; and individual factors, including age, life expectancy, quality of life issues, concurrent systemic diseases and patient expectations.
Diagnosis of uveal melanoma consists of careful examination of the eye by an experienced clinician. Clinical manifestations include tumor thickness more than 2 mm, sub retinal fluid, and orange pigment on the tumor surface. Various ancillary diagnostic tests include ultrasonography, high resolution ultrasound biomicroscopy, indocyanine green angiography, fluorescein angiography and oclular coherence tomography. Eye exams include ophthalmoscopy, slit-lamp biomicrocopy and gonioscopy.
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Eye examination is carried out by dilation of pupil with the help of medicated drops allowing doctors to visualize the parts of eye clearly through lens. Biopsy is a rarely used diagnostic test for intraocular melanoma. Regular eye examinations by an ophthalmologist are the best way to find uveal melanoma early, when chances for successful treatment are the highest.
The treatment for such metastasis disease is continuously demanding more research to determine the most effective, and life saving treatments. Extensive research is being carried out in areas of immunotherapy and targeted therapy. Ipilimumab is one such example of immunotherapy shown to help people with advanced melanoma to boost the overall immunity; however its benefits are still under clinical trials for eye melanoma. Other similar drugs under investigation include nivolumab and lambrolizumab. Selumetinib is an example of targeted drug known to slow down the growth of eye melanoma. Other targeted drugs under investigation include vemurafenib, dabrafenib and trametinib amongst various others. Astra Zeneca plc, Eli Lilly & Co., Pfizer, Inc. Novartis AG, and Spectrum Pharmaceuticals, Inc., are few key players contributing to the global uveal melanoma market.
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