Intraocular Melanoma: Current and Emerging Treatment Strategies

Abstract

Intraocular tumors occupy an important place among neoplasms of the eye, second in frequency after eyelid tumors.

Due to their high malignancy, uveal melanomas pose a threat both directly to the visual organ and to the patient's life itself.

It should be noted that in most cases (75%) uveal melanomas affect people of working age, and most often they are diagnosed at the age of 31 - 60 years.

Thus, the problem of developing new and improving existing methods of treating patients with uveal melanomas of the eye has not only scientific and applied, but also medical and social significance.

Currently, instead of the previously used enucleation of the eyeball, the emphasis is on organ-preserving treatment of uveal melanoma, the advantage of which is not only in preserving the eye, but also preserving vision in many patients. This is especially important for melanoma in the only sighted eye. Radiation therapy, laser therapy, new methods of intraocular surgery, chemotherapy, immunotherapy and their combination are used.

Also, in recent years, a large amount of information has accumulated in oncology, indicating a significant role of disorders of the mechanisms of immunological control in the initiation and development of the tumour process. This primarily concerns the suppression of the functional activity of immunocompetent cells, in particular T-dependent lymphocytes and mononuclear phagocytes in malignant tumours of various localisations, which was taken into account by us when developing an additional treatment method using alpha-2b-interferon (laferobion).

In this work, based on our own experience of practice in ophthalmic oncology for more than 45 years, we draw the attention of ophthalmic oncologists to the need for a systemic approach to the treatment of intraocular melanoma. In addition to traditional treatment methods, we have included alpha-2b-interferon (laferobion) (taking into account the body's antitumor resistance), selective intra-arterial chemotherapy in the treatment method to increase the sensitivity of tumor cells to local radiation therapy, as well as our own surgical developments in intraocular tumor excision using a radiowave knife (primarily for melanomas of the iris, ciliary body and preequatorial part of the choroid) and the method of high-frequency electric welding (choroidal melanoma). Our goal was to expand the indications for organ-preserving treatment of intraocular melanomas and reduce the percentage of surgical and postoperative complications. In our opinion, the work we have carried out and the results presented in the book may be of interest to ophthalmologists.

Keywords: Uveal melanoma, molecular markers of lymphocyte activation, photodestruction, brachytherapy, interferon therapy, intra-arterial chemotherapy, radiowave knife, transscleral resection of melanoma of the iridociliochoroidal region, endoresection, high-frequency electric welding, enucleation, musculoskeletal stump