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Although they have only a very small proportion of all melanomas, melanoma of the choroid (uveal melanoma) is the most common adult malignant tumor in the eye. One assumes from five to six new cases annually per 1,000,000 inhabitants, thus from 400 to 500 new cases nationwide.
Most of uveal melanomas, which lies between the leather and the iris; About 5% is in the iris and 10% in the ciliary body where the lens is suspended. Uveal melanomas develop almost exclusively on one side.
Uveal melanomas are more likely to affect light-skinned people and may be associated with the syndrome of dysplastic nevus (clinically evident birthmarks) or ocular melanomatosis.
Either the disease is discovered by chance in a routine examination, or the patient observes a vision deterioration or a flicker in the affected eye. Uveal melanomas are usually diagnosed by simple reflection of the fundus, that is, by visual examination of the pupil (augmented with eye drops).
Further examinations for the diagnosis are the ultrasound examination of the eye and the magnetic resonance tomography (MRT). Metastasis to other organs at diagnosis is rare. Nevertheless, at this time each patient is examined for distant metastases either by X-ray and ultrasound or by computer tomography.
The therapy of the eye tumor depends on its size and the exact location of the tumor (localization). In addition to the surgery, which removes the entire eye, local radiotherapy (brachytherapy) and irradiation with protons are available, which in 90 percent of cases allow the preservation of the eye.
In brachytherapy, a radioactive metal plate is sewn over the tumor outside of the eye and removed after a specified time. The irradiation by protons can only be done in a few centers in Germany. As a rule, there are four sessions of one minute each of irradiation, which can be performed without anesthesia. At present, the scientifically proven effectiveness of the so-called photodynamic therapy is unclear. Supportive (adjuvant) drug treatment currently has no scientific justification.