Choroidal Melanoma - Dr. David Sia

Choroidal melanoma is a malignant tumour that arises from the pigmented layers inside the eye. It can grow out of pre-existing choroidal naevi (moles) or as a new lesion.
If untreated, this tumour continues to grow and can cause loss of vision and potentially spread outside the eye (metastasise).
The potential to metastasise is determined by the genetic characteristics of the tumour, and this can be determined with a biopsy.
Dr. Sia is able to offer a biopsy procedure for ocular tumours to provide confirmation as well as prognosis on likelihood of metastasis.
As this is a malignant cancer, this condition requires urgent specialist assessment and treatment.
Treatment of choroidal melanoma is usually with plaque radiation therapy. In some cases where the tumour is too extensive, the eye may have to be removed (enucleation) in order to get rid of the tumour.

Plaque radiation therapy or plaque brachytherapy is a treatment where focal radiation is delivered to the tumour inside the eye by suturing a radioactive plaque to the outside of the eye.
This focused delivery allows the sparing of critical structures of the eye and body from unnecessary radiation damage.
This treatment involves two separate operations, usually a few days apart. The first operation is to insert the radioactive plaque and the second operation to remove it from the eye.
These procedures are performed under general anaesthesia at the Royal Adelaide Hospital.
Following insertion of the plaque, the patient is admitted to the hospital as an inpatient until the second operation. Visitors are allowed.
After the second operation, the patient can be discharged home with eye drops to use.
This procedure has a very high success rate of greater than 90% to treat the tumour in the eye.

Tumour biopsy is performed to either confirm a suspicious lesion or to provide prognostic information regarding risk of metastasis.
Depending on the location of the tumour, this procedure can be performed from the inside of the eye or from the outside.
It is usually performed at the same time as plaque radiation therapy but can be performed separately for indeterminate lesions.

This procedure involves removal of the eyeball, with the goal of removing the tumour completely as a whole. It is often employed in cases where the tumour is too extensive for plaque radiation therapy.
This operation is performed under general anaesthesia, usually with a few days of stay in the hospital to manage any post-operative discomfort.
During the procedure, muscles around the eye are detached before removal of the eyeball. An implant is then inserted to fill the space, and the muscles reattached to the implant.
The conjunctiva (skin around the eyeball) is then closed over the implant with sutures to form a socket.
After the socket is healed, the patient is fitted with a custom designed ocular prosthesis “artificial eye” that matches the appearance of their other eye and will have some degree of movement.