Modified Enucleation for Choroidal Melanoma with Large Extrascleral Extension

Purpose: To report the technique and the outcome of modified (enlarged) enucleation via lateral orbitotomy for choroidal melanomas with massive extrascleral extension. Methods: 5 patients with choroidal malanoma with massive, circumscribed perioptic /posterior extrascleral extension underwent modified enucleation via lateral orbitotomy. After lateral orbitotomy and orbital mass exposure with direct tumor visualization, a long optic nerve stump was cut and the orbital component of the tumor was completely (macroscopically) removed along with the globe in all cases. After haemostasis and orbital reconstruction an orbital implant was then placed. Follow-up was longer than 12 months. Results: Excellent cosmetic outcome was acheived in all patients (100%) without operative or postoperative complications. At pathologic examination, tumors were completely removed in all cases (100%). Conclusions: Modified (enlarged) enucleation via lateral orbitotomy for selectd choroidal melanomas with massive, circumscribed perioptic/posterior extrascleral extension allows complete tumor removal and placement of an orbital implant, avoiding the long healing process of orbital exenteration with excellent clinical and cosmetic outcome.