小脉络膜黑色素瘤：诊断、治疗结果及无尽的争议
The Small Choroidal Melanoma: Diagnosis, Treatment Outcomes, and Unending Controversy.
作者信息
Mishra Kapil, Mruthyunjaya Prithvi
机构信息
Gavin Herbert Eye Institute, University of California, Irvine, CA, USA.
Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA.
出版信息
Semin Ophthalmol. 2025 Mar 21:1-10. doi: 10.1080/08820538.2025.2480188.
PURPOSE
Small choroidal melanoma (SCM) remains a diagnostic challenge due to its clinical overlap with choroidal nevus. This overlap encompasses a wide clinical phenotype of lesions termed indeterminate choroidal lesions. Treating an indeterminate lesion is weighed against significant visual morbidity from local treatment versus increased metastatic risk with tumor size.
METHODS
This comprehensive review includes diagnosis, controversies, management, and future therapy options for small choroidal melanoma.
RESULTS
For diagnostically challenging cases, indeterminate choroidal lesions can be closely monitored for growth utilizing multimodal imaging. Tumor biopsies can be performed for either diagnostic purposes in indeterminate choroidal lesions or for metastatic risk prognostication in small choroidal melanomas. Several new treatment options exist to reduce the risk of radiation complications.
CONCLUSION
Despite significant advances in diagnostic imaging, molecular analysis, and treatment techniques for SCM, these tumors may still pose a challenge on appropriate timing and management options.
目的
小脉络膜黑色素瘤（SCM）由于其与脉络膜痣在临床上存在重叠，仍然是一个诊断难题。这种重叠涵盖了一系列被称为不确定脉络膜病变的广泛临床病变表型。对于不确定病变的治疗，需要权衡局部治疗带来的显著视觉损害与肿瘤大小增加导致的转移风险上升。
方法
本综述全面涵盖了小脉络膜黑色素瘤的诊断、争议、管理及未来治疗选择。
结果
对于诊断具有挑战性的病例，可利用多模态成像密切监测不确定脉络膜病变的生长情况。对于不确定脉络膜病变，可进行肿瘤活检以明确诊断，对于小脉络膜黑色素瘤，则可用于转移风险的预后评估。目前有几种新的治疗选择可降低放疗并发症的风险。
结论
尽管在SCM的诊断成像、分子分析和治疗技术方面取得了显著进展，但这些肿瘤在合适的时机选择和管理方案上仍可能构成挑战。
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