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Clinical imaging and high-resolution ultrasonography in melanocytoma management.

Gologorsky D, Schefler AC, Ehlies FJ, Raskauskas PA, Pina Y, Williams BK, Murray TG - Clin Ophthalmol (2010)

Bottom Line: The maximum elevation of any lesion was 2.6 mm.The vast majority (89%) of lesions had medium or high internal reflectivity and 89% demonstrated avascularity.Mean follow-up for all patients was nearly 7 years.

View Article: PubMed Central - PubMed

Affiliation: Dartmouth Medical School, Hanover, New Hampshire, USA.

ABSTRACT

Purpose: To demonstrate the utility of high resolution 20 MHz ophthalmic ultrasound in serial follow-up of optic nerve head melanocytoma patients.

Methods: This study is a retrospective review of 30 patients with melanocytoma of the optic nerve head studied with echography. All patients were evaluated with standard ophthalmic A-scan and B-scan ultrasonography and 10 (33%) underwent high-resolution ultrasound.

Results: Sixty-two percent (62%) of patients had dome-shaped lesions on ultrasound, twenty-eight percent (28%) presented with mild elevations. The maximum elevation of any lesion was 2.6 mm. The vast majority (89%) of lesions had medium or high internal reflectivity and 89% demonstrated avascularity. Mean follow-up for all patients was nearly 7 years. High-resolution ultrasound enabled enhanced accuracy for detection of lesion dimensions and documentation of growth and possible malignant transformation.

Conclusions: In this study, we demonstrate a new and important role for the use of ultrasound in this disease as a complementary tool in identifying and following patients with high-risk growth characteristics. These tumor characteristics can be accurately detected with 10 MHz ultrasound in conjunction with standardized A-scan and better differentiated with the 20 MHz technology. Use of these modalities can aid in distinguishing the melanocytomas that grow from choroidal melanomas and can prevent unnecessary treatments.

No MeSH data available.


Related in: MedlinePlus

Clinical imaging for Case #2. A) Fundus photo of the right eye demonstrating pigmented juxtapapillary lesion which remained stable in appearance for several years. B) B-scan ultrasound of the lesion from (A) with apical height of 1.3 mm. C) Appearance of the same lesion two years later. Note invasion into superior optic nerve head tissue, optic disc hemorrhage, and displacement of central retinal vessels. D) B-scan ultrasound of the lesion from (C) showing marked increase in height to 3.4 mm, with associated basal dimensional growth.
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f2-opth-4-855: Clinical imaging for Case #2. A) Fundus photo of the right eye demonstrating pigmented juxtapapillary lesion which remained stable in appearance for several years. B) B-scan ultrasound of the lesion from (A) with apical height of 1.3 mm. C) Appearance of the same lesion two years later. Note invasion into superior optic nerve head tissue, optic disc hemorrhage, and displacement of central retinal vessels. D) B-scan ultrasound of the lesion from (C) showing marked increase in height to 3.4 mm, with associated basal dimensional growth.

Mentions: A 45 year-old female with no significant past ocular history aside from an earlier thermal corneal injury was referred by an outside ophthalmologist for evaluation of an unknown fundus lesion. The patient’s visual acuity was 20/20 in both eyes. Funduscopic examination showed an irregular lesion overlying and surrounding the inferior aspect of the optic disc in the right eye (Figure 2A), and standard ultrasound demonstrated the dimensions of the low-reflective lesion to be 1.3 × 5 × 5 mm (apical × basal dimensions) with mild vascularity (Figure 2C). Although the lesion was too small for differentiation, internal characteristics were suggestive of melanoma. However, on clinical examination, a diagnosis of melanocytoma was established. The lesion was followed with serial ultrasound and remained stable in size until three years later, when examination revealed that the lesion had rapidly grown in size (Figure 2B). In conjunction with standardized A-scan, high-resolution 20 MHz B-scans were taken, definitively demonstrating the increased vasculature and growth of the lesion to 3.4 × 7 × 6.5 mm (Figure 2D). These features were suggestive of malignant transformation, confirming the new diagnosis of uveal melanoma. The patient subsequently underwent enucleation of her right eye. Histopathologic analysis demonstrated a malignant epithelioid melanoma arising from an area of polyhedral cells consistent with malignant transformation of a melanocytoma.


Clinical imaging and high-resolution ultrasonography in melanocytoma management.

Gologorsky D, Schefler AC, Ehlies FJ, Raskauskas PA, Pina Y, Williams BK, Murray TG - Clin Ophthalmol (2010)

Clinical imaging for Case #2. A) Fundus photo of the right eye demonstrating pigmented juxtapapillary lesion which remained stable in appearance for several years. B) B-scan ultrasound of the lesion from (A) with apical height of 1.3 mm. C) Appearance of the same lesion two years later. Note invasion into superior optic nerve head tissue, optic disc hemorrhage, and displacement of central retinal vessels. D) B-scan ultrasound of the lesion from (C) showing marked increase in height to 3.4 mm, with associated basal dimensional growth.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC2921292&req=5

f2-opth-4-855: Clinical imaging for Case #2. A) Fundus photo of the right eye demonstrating pigmented juxtapapillary lesion which remained stable in appearance for several years. B) B-scan ultrasound of the lesion from (A) with apical height of 1.3 mm. C) Appearance of the same lesion two years later. Note invasion into superior optic nerve head tissue, optic disc hemorrhage, and displacement of central retinal vessels. D) B-scan ultrasound of the lesion from (C) showing marked increase in height to 3.4 mm, with associated basal dimensional growth.
Mentions: A 45 year-old female with no significant past ocular history aside from an earlier thermal corneal injury was referred by an outside ophthalmologist for evaluation of an unknown fundus lesion. The patient’s visual acuity was 20/20 in both eyes. Funduscopic examination showed an irregular lesion overlying and surrounding the inferior aspect of the optic disc in the right eye (Figure 2A), and standard ultrasound demonstrated the dimensions of the low-reflective lesion to be 1.3 × 5 × 5 mm (apical × basal dimensions) with mild vascularity (Figure 2C). Although the lesion was too small for differentiation, internal characteristics were suggestive of melanoma. However, on clinical examination, a diagnosis of melanocytoma was established. The lesion was followed with serial ultrasound and remained stable in size until three years later, when examination revealed that the lesion had rapidly grown in size (Figure 2B). In conjunction with standardized A-scan, high-resolution 20 MHz B-scans were taken, definitively demonstrating the increased vasculature and growth of the lesion to 3.4 × 7 × 6.5 mm (Figure 2D). These features were suggestive of malignant transformation, confirming the new diagnosis of uveal melanoma. The patient subsequently underwent enucleation of her right eye. Histopathologic analysis demonstrated a malignant epithelioid melanoma arising from an area of polyhedral cells consistent with malignant transformation of a melanocytoma.

Bottom Line: The maximum elevation of any lesion was 2.6 mm.The vast majority (89%) of lesions had medium or high internal reflectivity and 89% demonstrated avascularity.Mean follow-up for all patients was nearly 7 years.

View Article: PubMed Central - PubMed

Affiliation: Dartmouth Medical School, Hanover, New Hampshire, USA.

ABSTRACT

Purpose: To demonstrate the utility of high resolution 20 MHz ophthalmic ultrasound in serial follow-up of optic nerve head melanocytoma patients.

Methods: This study is a retrospective review of 30 patients with melanocytoma of the optic nerve head studied with echography. All patients were evaluated with standard ophthalmic A-scan and B-scan ultrasonography and 10 (33%) underwent high-resolution ultrasound.

Results: Sixty-two percent (62%) of patients had dome-shaped lesions on ultrasound, twenty-eight percent (28%) presented with mild elevations. The maximum elevation of any lesion was 2.6 mm. The vast majority (89%) of lesions had medium or high internal reflectivity and 89% demonstrated avascularity. Mean follow-up for all patients was nearly 7 years. High-resolution ultrasound enabled enhanced accuracy for detection of lesion dimensions and documentation of growth and possible malignant transformation.

Conclusions: In this study, we demonstrate a new and important role for the use of ultrasound in this disease as a complementary tool in identifying and following patients with high-risk growth characteristics. These tumor characteristics can be accurately detected with 10 MHz ultrasound in conjunction with standardized A-scan and better differentiated with the 20 MHz technology. Use of these modalities can aid in distinguishing the melanocytomas that grow from choroidal melanomas and can prevent unnecessary treatments.

No MeSH data available.


Related in: MedlinePlus