GIANT MALIGN OCULAR MELANOMA TREATED BY SELECTIVE ARTERIAL EMBOLIZATION AND EXENTERATION. CASE REPORT

Although rare, uveal melanoma is the most frequent primary malign tumor of the eye in adult population. If discovered in early phase, several conservative therapies are available, which can help the patient to preserve the eye and even the visual function: brachytherapy, proton beam radiotherapy, stereotactic radiotherapy, laser ablation or endo photocoagulation and limited resection of the tumor. In up to 40% of cases, enucleation is required due to tumoral increased size, while exenteration is required only exceptionally, in loco-regional advanced tumors. The paper presents the case of a patient diagnosed with ocular melanoma 12 years ago but refused surgery. She returns with a giant tumoral mass, complete disorganization of the eyeball and extensive extraocular lateral invasion, but no metastatic disease. Selective arterial embolization under angiographic control followed by exenteration were performed, with no local or at distance recurrence in a 2-year follow-up period. The disease course was favorable, despite many risk factors for poor prognosis. The patient is still checked regularly for metastatic disease, which remain a high risk for the following 10-15 years. Conclusions: Angiographic embolization may reduce the intraoperative risk of hematogenous dissemination and improve survival in regionally advanced ocular melanomas. The case was challenging due to increased size of the tumor, yet the predominantly lateral extension, spearing the orbital bones and intraconal space were positive factors for favorable outcome.