Malignant melanoma of the uvea: surgical techniques

Purpose To describe the surgical techniques in the management of uveal melanoma. Methods The surgical techniques include: excision-, incision-, and aspiration-biopsy; various forms of exo-resection and endoresection; enucleation and exenteration. Local resection and enucleation can be primary or secondary. Results Biopsy greatly enhances prognostication by allowing multivariate analysis of clinical, histological and genetic predictors of metastasis. Primary local resection is indicated in only a minority of patients, in whom radiotherapy is unlikely to be successful, because of tumour size or location. The role of neoadjuvant radiotherapy is controversial. Secondary local resection can salvage eyes with local tumour recurrence or the toxic tumour syndrome after radiotherapy. Enucleation may be necessary because the tumour is too extensive when the patient presents or because of complications after conservative forms of therapy. Conclusion The results of biopsy and surgical treatment are highly surgeon-dependent and require appropriate skills if complications are to be avoided. Intensive efforts are required to ensure that skills are transferred between surgeons so that technical advances are not forgotten.