Surgical Considerations of Radiation Plaques and Enucleation

Since the Collaborative Ocular Melanoma Study (COMS) reported similar mortality rates between enucleation and plaque brachytherapy for patients with medium-sized choroidal melanoma, radiation plaques have become the standard method of treatment for uveal melanoma. However, enucleation remains a valid primary treatment technique in some cases of melanoma with specific surgical indications, risks, and benefits. Today, most physicians evaluate the size and location of the tumor, the presence of extrascleral extensions, feasibility of vision retention, and patient preference when deciding between surgical options, although controversy remains regarding the best treatment course for small-and large-sized tumors. In recent years, genetic profiling has also become an important factor in deciding metastatic risk in uveal melanoma, and fine needle aspiration biopsy is now an important step in assessing melanoma prognosis.