Hungerford J L
Moorfields Eye Hospital, West Smithfield, London, UK.
Melanoma Res. 1993 Oct;3(5):305-12. doi: 10.1097/00008390-199310000-00001.
Malignant melanomas may arise in the uveal tract, the conjunctiva, the skin of the eyelid, or the orbit. Risk factors so far identified include pre-existing choroidal naevi for uveal melanomas, primary acquired melanosis (PAM) for conjunctival tumours, and ocular and oculodermal melanocytosis for uveal and orbital lesions. The atypical mole syndrome (AMS) is associated with uveal and conjunctival melanomas, especially when the ocular lesions are multiple or familial. AMS patients should be screened for ocular melanomas. Conjunctival melanomas are managed by excision with or without adjunctive beta-irradiation. Circumscribed tumours have a better prognosis than diffuse and multifocal lesions arising in acquired melanosis and attempts should be made to limit the progress of the latter variant of the disease by treating PAM with cryotherapy. The most significant prognostic factor in uveal melanoma is the size of the tumour at presentation. Early dissemination is the rule and every effort should be made to distinguish a melanoma from a naevus as soon as possible. Small and medium-sized melanomas respond well to focal treatments chosen according to the size and location of the tumour. The techniques employed include photocoagulation, radioactive plaque therapy, proton beam radiotherapy and surgical resection.
恶性黑色素瘤可发生于葡萄膜、结膜、眼睑皮肤或眼眶。目前已确定的危险因素包括葡萄膜黑色素瘤的既往脉络膜痣、结膜肿瘤的原发性后天性黑素沉着症（PAM）以及葡萄膜和眼眶病变的眼及眼皮肤黑素细胞增多症。非典型痣综合征（AMS）与葡萄膜和结膜黑色素瘤相关，尤其是当眼部病变为多发性或家族性时。AMS患者应接受眼部黑色素瘤筛查。结膜黑色素瘤通过手术切除并辅以或不辅以β射线照射进行治疗。局限性肿瘤的预后优于后天性黑素沉着症中出现的弥漫性和多灶性病变，应尝试通过冷冻疗法治疗PAM来限制该疾病后一种变体的进展。葡萄膜黑色素瘤最重要的预后因素是就诊时肿瘤的大小。早期转移是常见情况，应尽快努力将黑色素瘤与痣区分开来。中小型黑色素瘤对根据肿瘤大小和位置选择的局部治疗反应良好。所采用的技术包括光凝、放射性敷贴治疗、质子束放疗和手术切除。
