Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Curr Opin Ophthalmol. 2019 May;30(3):206-214. doi: 10.1097/ICU.0000000000000560.
To explore risk factors for choroidal nevus transformation into melanoma using multimodal imaging and review current treatment options.
A recently published longitudinal study of 3806 choroidal nevi, imaged with optical coherence tomography (OCT), ultrasonography, and standard wavelength autofluorescence, revealed transformation into melanoma in 5.8% at 5 years and 13.9% at 10 years, using Kaplan-Meier analysis. Multivariate factors predictive of transformation included thickness more than 2 mm (by ultrasonography), fluid subretinal (by OCT), symptoms vision loss (by Snellen acuity), orange pigment (by autofluorescence), melanoma hollow (by ultrasonography), and DIaMeter more than 5 mm (by photography). These important factors can be recalled by the mnemonic 'To Find Small Ocular Melanoma Doing IMaging' (TFSOM-DIM). The mean 5-year estimate of nevus growth into melanoma was 1.1% for those with 0 risk factor, 11% with one factor, 22% with two factors, 34% with three factors, 51% with four factors, and 55% with five risk factors. Management of small choroidal melanoma typically involves plaque radiotherapy with 5 and 10-year rates of tumor recurrence at 7 and 11%, visual acuity loss (≥3 Snellen lines) at 39 and 49%, and melanoma-related metastasis at 4 and 9%. A novel infrared dye-conjugated virus-like nanoparticle (AU-011) is currently under investigation for treatment of small choroidal melanoma, with a goal to induce tumor regression and minimize vision loss.
The mnemonic, TFSOM-DIM, can assist the clinician in detection of small choroidal melanoma. Treatment of small melanoma with plaque radiotherapy offers tumor control but with potential vision loss. A novel nanoparticle therapy using AU-011 is currently under trial.
利用多模态成像探讨脉络膜痣恶变为黑色素瘤的危险因素，并综述目前的治疗选择。
最近发表的一项对 3806 例脉络膜痣的纵向研究，采用光学相干断层扫描（OCT）、超声和标准波长自发荧光成像，通过 Kaplan-Meier 分析发现，5 年时黑色素瘤转化率为 5.8%，10 年时为 13.9%。多变量因素预测恶变包括厚度超过 2mm（超声）、视网膜下积液（OCT）、视力丧失（视力表）、橙色色素（自发荧光）、黑色素瘤空洞（超声）和直径超过 5mm（摄影）。这些重要因素可以通过记忆法“To Find Small Ocular Melanoma Doing IMaging”（TFSOM-DIM）来回忆。对于没有危险因素的患者，5 年内痣恶变为黑色素瘤的平均估计值为 1.1%，有 1 个危险因素的患者为 11%，有 2 个危险因素的患者为 22%，有 3 个危险因素的患者为 34%，有 4 个危险因素的患者为 51%，有 5 个危险因素的患者为 55%。小脉络膜黑色素瘤的典型治疗方法是采用斑块放射治疗，5 年和 10 年的肿瘤复发率分别为 7%和 11%，视力丧失（≥3 行视力表）率分别为 39%和 49%，黑色素瘤相关转移率分别为 4%和 9%。目前正在研究一种新型近红外染料偶联病毒样纳米颗粒（AU-011）治疗小脉络膜黑色素瘤，目的是诱导肿瘤消退，减少视力丧失。
记忆法 TFSOM-DIM 可以帮助临床医生发现小脉络膜黑色素瘤。用斑块放射治疗小黑色素瘤可以控制肿瘤，但可能会导致视力丧失。目前正在试用一种新型的 AU-011 纳米颗粒治疗。
