Iris melanoma in children: Current approach to management
A 15-year-old Caucasian male noticed a brown nodule in the inferotemporal aspect of his left eye (OS) for 1 month []. On examination, visual acuities were 20/20 in both eyes (OU) with intraocular pressures (IOP) of 11mm Hg OU. The right eye (OD) was unremarkable except for a single iris freckle. In the left eye, a pigmented nodular iris lesion was noted in the five o’clock meridian, extending to the pupillary margin and measuring 3.0 mm in basal diameter and 1.3 mm in thickness. Intrinsic vascularization, feeder vessels, corectopia and ectropion irides were present. There was a light dusting of pigment on the anterior iris surface. The anterior chamber angle showed no sign of tumor or tumor-related seeds. Subtle scleral and choroidal melanocytosis was present OS. The differential diagnosis included iris nevus versus iris melanoma and conservative observation for growth was advised.\nNearly 2 years after initial presentation, the lesion had enlarged to 3.5 mm in basal diameter and 3.0 mm in thickness []. IOP was 10 mm Hg OD and 12 mm Hg OS. Iris melanoma was diagnosed, and the tumor was surgically excised by partial lamellar scleral flap and sector iridectomy []. Histopathology confirmed the diagnosis of spindle iris melanoma.\nOver 2 years, following iridectomy the patient developed elevated IOP OS of 37mm Hg. Gonioscopy disclosed lightly pigmented tumor invasion of the trabecular meshwork for 360 degrees and melanoma recurrence was suspected. This finding was managed with custom designed Iodine125 plaque radiotherapy, delivering transcorneal radiation to the entire anterior segment, including the entire trabecular meshwork []. The only other alternative was enucleation.