Preauricular lymph nodes: Causes of swelling

Diagnosis And Prognosis Of Uveal Melanoma

EP. 1: Overview of Uveal Melanoma

EP. 2: Diagnosis and Prognosis of Uveal Melanoma

EP. 3: The Metastatic Uveal Melanoma Treatment Landscape

EP. 4: Efficacy and Safety of Tebentafusp in the Treatment of Metastatic Uveal Melanoma

EP. 5: Tebentafusp Treatment Protocol in Metastatic Uveal Melanoma

EP. 6: Advice for Patients Diagnosed with Metastatic Uveal Melanoma

Transcript:

How does uveal melanoma typically present and how is it diagnosed?

Marlana M. Orloff, M.D.: Patients with uveal melanoma can present in a couple of different ways. Some patients have a freckle in the eye that's followed over time. Other patients just show up for a routine eye exam and it's found. But most patients do have some sort of visual disturbance that brings them first to the eye doctor. Oftentimes, it's retinal detachment symptoms like flashes and floaters. Patients will first see an eye doctor, are often then referred to a retina specialist, and then ultimately an ocular oncologist, who uses ultrasound and direct visualization to diagnose the eye melanoma.

What is the typical prognosis for patients diagnosed with uveal melanoma? How is the primary tumor treated?

Marlana M. Orloff, M.D.: Once the diagnosis of uveal melanoma is made, the ocular oncologist often discusses with the patient options for treatment of the primary tumor. This could [be] plaque radiation, nucleation, removal of the eye, or external radiation. Primary treatment of the eye tumor, regardless of the method, is very effective. The risk of it coming back in the eye is actually quite low. Patients are then often referred to a medical oncologist for surveillance to make sure that the cancer doesn't come back in other parts of the body.

Despite the very effective treatment of the primary tumor, about half of the patients—and this is all comers—can recur with the cancer most commonly in the liver at some point after the primary eye diagnosis. We think that before the eye tumor is even treated, it's possible that some cells could have gotten out and could lead to metastasis in the future. Because we don't have the ability to really search for those single cells floating around, we rely on information about the primary tumor like the size and genetics to try to estimate what a patient's risk is. For patients with very large tumors, we think their risk may be a little bit higher. Patients with things like monosomy 3, 8q amplification, or something called a class 2 genetic signature may have a greater than 50% risk of the cancer returning. Depending on a patient's risk assessed by tumor size and genetics, we then monitor patients. The higher the risk, the closer we follow them. And often following these patients involves a series of things like MRIs, CT scans, and meeting with a medical oncologist.

Transcript edited for clarity.

Melanoma & Non-Melanoma Skin Cancer Resource Center

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Macular Degeneration

Age-related macular degeneration (AMD) is a medical condition which usually affects older adults and results in a loss of vision in the center of the visual field (the macula) because of damage to the retina. It occurs in "dry" and "wet" forms. It is a major cause of blindness and visual impairment in older adults (>50 years). Macular degeneration can make it difficult or impossible to read or recognize faces, although enough peripheral vision remains to allow other activities of daily life.

Starting from the inside of the eye and going towards the back, the three main layers at the back of the eye are the retina, which contains the nerves; the choroid, which contains the blood supply; and the sclera, which is the white of the eye.

The macula is the central area of the retina, which provides the most detailed central vision.

In the dry (nonexudative) form, cellular debris called drusen accumulate between the retina and the choroid, and the retina can become detached. In the wet (exudative) form, which is more severe, blood vessels grow up from the choroid behind the retina, and the retina can also become detached. It can be treated with laser coagulation, and with medication that stops and sometimes reverses the growth of blood vessels.

Although some macular dystrophies affecting younger individuals are sometimes referred to as macular degeneration, the term generally refers to age-related macular degeneration (AMD or ARMD).

Age-related macular degeneration begins with characteristic yellow deposits (drusen) in the macula, between the retinal pigment epithelium and the underlying choroid. Most people with these early changes (referred to as age-related maculopathy) have good vision. People with drusen can go on to develop advanced AMD. The risk is considerably higher when the drusen are large and numerous and associated with disturbance in the pigmented cell layer under the macula. Recent research suggests that large and soft drusen are related to elevated cholesterol deposits and may respond to cholesterol-lowering agents.

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