In this oncology issue, we will explore advances in tumor diagnosis and therapy as it relates to retina specialists. Because most of us do not treat ocular tumor patients, instead sending them to eye-cancer gurus in academic centers, we are devoting this issue to keeping readers up to date on all things related to eye cancer.
The diagnosis of choroidal malignant melanoma is usually straightforward. The Collaborative Ocular Melanoma Study (COMS) found that eye cancer specialists could correctly identify melanoma in over 99% of cases without a biopsy. Regardless, sometimes the diagnosis is missed or, more likely, patients are sent incorrectly to the tumor specialist. Understanding masquerade syndromes is imperative to reducing these errors. A primer to assist is included in this issue.
The best treatment has been argued for years. I can remember during my residency the argument was whether proton-beam therapy was superior to plaque brachytherapy. Since there were few places equipped to perform proton beam, plaque brachytherapy became the dominant treatment. During my fellowship, the COMS reported the findings about the best therapy for medium and large tumors, but there were still questions about small tumors. Mnemonics became useful for those of us needing recertification to remember the signs about which to be concerned. However, things may change in the management of these small tumors. The early-phase results of a novel photodynamic therapy were presented at ARVO 2019 and are outlined in this issue. The results are very promising, but we need to wait for the phase 3 results and long-term tumor control to decide if this is the best therapy for small tumors.
For the majority of readers of Retinal Physician, it can be interesting and new to explore current tumor management. When should you perform a biopsy? What tests should you order on the specimen? What is the best intravitreal chemotherapy agent? When should intravitreal chemotherapy be done? We truly hope you enjoy this issue as much as our contributors did preparing it. RP
Listen to episodes of Straight From the Cutter’s Mouth with discussion of Retinal Physician articles.