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What Is Iris Melanoma?

Iris melanoma is a malignant tumor that arises from pigment cells in the iris, the colored part of the eye. It often develops from a preexisting nevus but can appear de novo as a new pigmented or variably colored mass. Lesions can distort the pupil, create ectropion uveae, or seed tumor cells into the anterior chamber angle. Most iris melanomas grow slowly and have a lower metastatic rate than posterior uveal melanomas, but careful monitoring is still needed.

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What Is Iris Melanoma?

Iris melanoma is a malignant tumor that arises from pigment cells in the iris, the colored part of the eye. It often develops from a preexisting nevus but can appear de novo as a new pigmented or variably colored mass. Lesions can distort the pupil, create ectropion uveae, or seed tumor cells into the anterior chamber angle. Most iris melanomas grow slowly and have a lower metastatic rate than posterior uveal melanomas, but careful monitoring is still needed.

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Clinical Features and Warning Signs

Iris melanomas usually present as nodular or diffuse pigmented lesions that enlarge over time. Color ranges from light brown to dark brown or even amelanotic, and surface vascularity can be prominent. Signs that raise concern include documented growth, secondary glaucoma, seeding to the angle, and localized hyphema. Some patients notice a change in iris color or pupil shape. Slit lamp examination and gonioscopy are central for evaluation.

Diagnosis and Imaging

Diagnosis is based on clinical appearance, growth documentation, and imaging studies. High frequency ultrasound biomicroscopy measures tumor thickness and extension into the ciliary body or angle. Transillumination and anterior segment optical coherence tomography add detail in selected cases. Fine needle aspiration biopsy is reserved for uncertain lesions where results would change management. Distinguishing iris melanoma from benign nevus, iris cysts, and other tumors is an important part of the workup.

Treatment Options

Management depends on tumor size, location, and documented growth. Small, stable lesions without high risk features are sometimes observed with photography and regular follow up. For growing or high risk tumors, treatment choices include sector iridectomy, iridocyclectomy, or plaque brachytherapy. In rare very large or invasive tumors, enucleation is considered. Intraocular pressure is monitored closely, because angle seeding and pigment dispersion can cause secondary glaucoma.

Prognosis and Systemic Surveillance

The prognosis for iris melanoma is generally more favorable than for choroidal melanoma, but metastatic spread can still occur. Long term follow up includes periodic liver and systemic imaging according to oncology guidance. Eye examinations track local control, recurrence, and glaucoma status. Patients are counseled about symptoms such as new pain, redness, or visual change that should prompt earlier review. Family history of uveal melanoma or related syndromes is discussed when relevant.

FAQs About Iris Melanoma

How is an iris melanoma different from an iris nevus?

An iris nevus is a benign pigmented spot that stays stable in size, while a melanoma shows growth, seeding, or other aggressive features over time.

Does iris melanoma always need to be removed?

Small, stable lesions can sometimes be observed carefully, but documented growth or high risk signs usually lead to surgery or radiation.

Can iris melanoma spread to the rest of the body?

Yes, metastasis can occur, most often to the liver, which is why systemic surveillance is part of long term care.

Will treatment for iris melanoma affect my vision?

Sector surgery or radiation can change pupil shape and cause localized cataract, but many patients keep useful vision, especially when tumors are treated early.

References

EyeWiki. ?Iris Melanoma.? https://eyewiki.org/Iris_Melanoma

National Cancer Institute (NCI). ?Intraocular (Uveal) Melanoma Treatment (PDQ?)?Patient Version.? https://www.cancer.gov/types/eye/patient/intraocular-melanoma-treatment-pdq

NCBI Bookshelf. ?Benign and Malignant Iris Tumors.? https://www.ncbi.nlm.nih.gov/books/NBK599520/

American Cancer Society. ?Treating Eye Melanoma by Location and Size.? https://www.cancer.org/cancer/types/eye-cancer/treating/uveal-melanoma.html

Mayo Clinic. ?Eye melanoma - Symptoms and causes.? https://www.mayoclinic.org/diseases-conditions/eye-melanoma/symptoms-causes/syc-20372371