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{{Uveal melanoma}}
{{Uveal melanoma}}
{{CMG}}{{AE}}{{Simrat}}
{{CMG}}{{AE}} {{Fs}}, {{Simrat}}
==Overview==
==Overview==
Uveal melanoma may be classified into several subtypes based on their location, based on ophthalmoscopic examination and based on the [[cell]] type. According to the Callender classification, there are four subtypes of uveal melanoma based on the cell type.  
[[Uvea (anatomy)|Uveal]] [[melanoma]] may be classified according to [[Cell (biology)|cell]] type into 5 subtypes: [[Spindle cells|Spindle]] A, [[Spindle cells|spindle]] B, epitheliolid, mixed, and [[necrotic]]. [[Uvea (anatomy)|Uveal]] [[melanoma]] may also be classified according to its location into 2 types, anterior [[Uvea (anatomy)|uveal]] [[melanoma]] which contain [[iris]] [[melanoma]], and posterior [[Uvea (anatomy)|uveal]] [[melanoma]] which contains [[ciliary body]] [[melanoma]] and chroidal [[melanoma]].
 
==Classification==
==Classification==
===Classification based on location===
[[Uvea (anatomy)|Uveal]] [[melanoma]] may be classified according to [[Cell (biology)|cell]] type into 5 subtypes: [[Spindle cells|Spindle]] A, [[Spindle cells|spindle]] B, epitheliolid, mixed, and [[necrotic]].<ref name="McLeanFoster1983">{{cite journal|last1=McLean|first1=Ian W.|last2=Foster|first2=Walter D.|last3=Zimmerman|first3=Lorenz E.|last4=Gamel|first4=John W.|title=Modifications of Callender's Classification of Uveal Melanoma at the Armed Forces Institute of Pathology|journal=American Journal of Ophthalmology|volume=96|issue=4|year=1983|pages=502–509|issn=00029394|doi=10.1016/S0002-9394(14)77914-0}}</ref>
*Posterior uveal melanoma
 
:Posterior uveal melanoma refers to the involvement of the [[posterior]] [[choroid]]. The choroid posterior to the equator, is referred to as the posterior choroid, and is the most common site involved in uveal melanoma. Approximately 85% of cases of uveal melanoma are localized to this region.
{|
*Anterior uveal melanoma
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cell type
:Anterior uveal melanoma refers to the involvement of the [[iris]], [[ciliary body]], and/or choroid anterior to the equator. Anterior uveal melanoma comprises approximately 9-15% of uveal melanomas.
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Explanation
===Classification based on ophthalmoscopic examination===
|-
Kanski and Eichhorn-Mulligan et all classified choroidal pigmented lesions into three groups based on ophthalmoscopic examination.<ref name="Shields2001">{{cite journal|last1=Shields|first1=C. L|title=Factors associated with elevated intraocular pressure in eyes with iris melanoma|journal=British Journal of Ophthalmology|volume=85|issue=6|year=2001|pages=666–669|issn=00071161|doi=10.1136/bjo.85.6.666}}</ref><ref>Kanski, Jack J. Clinical diagnosis in ophthalmology. St. Louis, Mo. London: Elsevier Mosby, 2006. Print.</ref>
! style="background: #DCDCDC; text-align: center;" |Spindle A
*Group I
| style="background: #F5F5F5;" |
**The first group is benign and is characterized by small, flat, unchanging lesions that clearly appear as [[choroidal]] [[nevi]] on ophthalmoscopic exam without observation of the features that suggest [[metastasis]] such as [[macular]] involvement, large-caliber vessels, serous [[retinal detachment]], and lesion thickness greater than 2.5 mm.
* Fine [[nuclear]] [[chromatin]]
*Group II
 
**The second group is described as intermediate lesions.
*[[Cell (biology)|Cells]] with small spindle nuclei and central dark stripe
**These lesions are small with thickness less than 2.5 mm.
* No distinct [[nucleoli]]
**These lesions may have subretinal fluid or an orange [[lipofuscin]] pigmentation and one of the features suggestive of [[melanoma]] mentioned above. The second group is described as intermediate lesions; these lesions are small with thickness less than 2.5 mm that may have an orange lipofuscin pigmentation or subretinal fluid and one of the features suggestive of melanoma such as macular involvement, large-caliber vessels, and serous retinal detachment.
* Rare [[mitotic]] features
*Group III
|-
**The third group has the highest risk of melanoma.
! style="background: #DCDCDC; text-align: center;" |Spindle B
**These lesions are often large, dome or mushroom shaped choroidal tumors with surface vasculature and orange lipofuscin pigmentation.
| style="background: #F5F5F5;" |
**The tumor thickness  is greater than 2.5 mm.
* Commen
 
* Coarse [[nuclear]] [[chromatin]]
* Distinct [[nucleoli]]
* Rare [[mitotic]] features
 
|-
! style="background: #DCDCDC; text-align: center;" |Epithelioid
| style="background: #F5F5F5;" |
* Rarest
* Large round [[nuclei]]
* Prominent [[nucleoli]]
*[[Mitotic]] features are common
|-
! style="background: #DCDCDC; text-align: center;" |Mixed
| style="background: #F5F5F5;" |
* Most common
* Contains both [[spindle cells]] and epithelioil cells
|-
! style="background: #DCDCDC; text-align: center;" |Necrotic
| style="background: #F5F5F5;" |
* uncommon
 
*[[Necrotic]] [[tumor]] with unidentifiable [[cell]] type
|}
 
[[Uvea (anatomy)|Uveal]] [[melanoma]] may also be classified according to its location into 2 types:
* Anterior [[Uvea (anatomy)|uveal]] [[melanoma]]
**[[Iris]] [[melanoma]]
* Posterior [[Uvea (anatomy)|uveal]] [[melanoma]]
**[[Ciliary body]]  [[melanoma]]
** Chroidal [[melanoma]]


===Classification based on size===
[[File:Untitledd.png|500px|none|thumb|source: {{Fs}}]]
According to Collaborative Ocular Melanoma Study Group, there are three types of uveal melanoma based on tumor size.<ref name="vanKoopmans2013">{{cite journal|last1=van|first1=J.G.M.|last2=Koopmans|first2=A.E.|last3=Verdijk|first3=R.M.|last4=Naus|first4=N.C.|last5=de|first5=A.|last6=Kilic|first6=E.|title=Diagnosis, Histopathologic and Genetic Classification of Uveal Melanoma|year=2013|doi=10.5772/53631}}</ref>
*Small [[melanomas]] are 1.0 - 2.5 mm in apical height and > 5.0 mm in largest basal dimension.
*Medium [[tumors]] are defined as tumors 2.5 to 10 mm in apical height and ≤ 16 mm in largest basal diameter.
*Large tumors are ≥ 2 mm in apical height and > 16 mm in maximal basal diameter, or a melanoma > 10 mm in apical height, regardless of the basal diameter.


===Classification based on cell type===
Uveal melanomas originate from melanocytes in the uveal tract. According to the revised Callender classification there are four distinct cellular types.<ref name="NCI">Uveal melanoma. National Cancer Institute(2015) http://www.cancer.gov/types/eye/hp/intraocular-melanoma-treatment-pdq#section/_95 Accessed on October 20 2015</ref>
*Spindle-A [[cells]] (spindle-shaped cells with slender nuclei and lacking visible nucleoli).
*Spindle-B cells (spindle-shaped cells with larger nuclei and distinct nucleoli).
*[[Epithelioid]] cells (larger polygonal cells with one or more prominent [[nucleoli]]).
*Intermediate cells (similar to but smaller than epithelioid cells).
Most primary intraocular melanomas contain variable proportions of epithelioid, spindle-A, and spindle-B cells (mixed-cell melanomas).
Pure epithelioid-cell primary melanomas are infrequent (approximately 3% of cases).
In the Collaborative Ocular Melanoma Study, mixed-cell type melanomas predominated (86% of cases).
== References ==  
== References ==  
{{reflist|2}}
{{reflist|2}}
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Ophthalmology]]
[[Category:Up-To-Date]]
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[[Category:Medicine]]
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[[Category:Ophthalmology]]

Latest revision as of 17:11, 1 July 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D., Simrat Sarai, M.D. [2]

Overview

Uveal melanoma may be classified according to cell type into 5 subtypes: Spindle A, spindle B, epitheliolid, mixed, and necrotic. Uveal melanoma may also be classified according to its location into 2 types, anterior uveal melanoma which contain iris melanoma, and posterior uveal melanoma which contains ciliary body melanoma and chroidal melanoma.

Classification

Uveal melanoma may be classified according to cell type into 5 subtypes: Spindle A, spindle B, epitheliolid, mixed, and necrotic.[1]

Cell type Explanation
Spindle A
Spindle B
  • Commen
Epithelioid
Mixed
Necrotic
  • uncommon

Uveal melanoma may also be classified according to its location into 2 types:

source: Fahimeh Shojaei, M.D.

References

  1. ↑ McLean, Ian W.; Foster, Walter D.; Zimmerman, Lorenz E.; Gamel, John W. (1983). "Modifications of Callender's Classification of Uveal Melanoma at the Armed Forces Institute of Pathology". American Journal of Ophthalmology. 96 (4): 502–509. doi:10.1016/S0002-9394(14)77914-0. ISSN 0002-9394.

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