title: Clinical and pathologic characteristics of biopsy-proven iris melanoma: a multicenter international study.
abstract: OBJECTIVE
  To collaborate with multiple centers to identify representative epidemiological, clinical, and pathologic characteristics of melanoma of the iris. This international, multicenter, Internet-assisted study in ophthalmic oncology demonstrates the collaboration among eye cancer specialists to stage and describe the clinical and pathologic characteristics of biopsy-proven melanoma of the iris.
  
  
  METHODS
  A computer program was created to allow for Internet-assisted multicenter, privacy-protected, online data entry. Eight eye cancer centers in 6 countries performed retrospective chart reviews. Statistical analysis included patient and tumor characteristics, ocular and angle abnormalities, management, histopathology, and outcomes.
  
  
  RESULTS
  A total of 131 patients with iris melanoma (mean age, 64 years [range, 20-100 years]) were found to have blue-gray (62.2%), green-hazel (29.1%), or brown (8.7%) irides. Iris melanoma color was brown (65.6%), amelanotic (9.9%), and multicolored (6.9%). A mean of 2.5 clock hours of iris was visibly involved with melanoma, typically centered at the 6-o'clock meridian. Presentations included iritis, glaucoma, hyphema, and sector cataract. High-frequency ultrasonography revealed a largest mean tumor diameter of 4.9 mm, a mean maximum tumor thickness of 1.9 mm, angle blunting (52%), iris root disinsertion (9%), and posterior iris pigment epithelium displacement (9%). Using the American Joint Commission on Cancer-International Union Against Cancer classification, we identified 56% of tumors as T1, 34% of tumors as T2, 2% of tumors as T3, and 1% of tumors as T4. Histopathologic grades were G1-spindle (54%), G2-mixed (28%), G3-epithelioid (5%), and undetermined (13%) cell types. Primary treatment involved radiation (26%) and surgery (64%). Kaplan-Meier analysis found a 10.7% risk of metastatic melanoma at 5 years.
  
  
  CONCLUSIONS
  Iris melanomas were most likely to be brown and found in the inferior quadrants of patients with light irides. Typically small and unifocal, melanomas are commonly associated with angle blunting and spindle cell histopathology. This multicenter, Internet-based, international study successfully pooled data and extracted information on biopsy-proven melanoma of the iris.
authors.affiliation: The New York Eye Cancer Center, New York University School of Medicine, The New York Eye and Ear Infirmary, New York City, USA.
authors.forename: Samira
authors.initials: S
authors.lastname: Khan
authors.forename: Paul T
authors.initials: PT
authors.lastname: Finger
authors.forename: Guo-Pei
authors.initials: GP
authors.lastname: Yu
authors.forename: Lubna
authors.initials: L
authors.lastname: Razzaq
authors.forename: Martine J
authors.initials: MJ
authors.lastname: Jager
authors.forename: Rob J W
authors.initials: RJ
authors.lastname: de Keizer
authors.forename: Per
authors.initials: P
authors.lastname: Sandkull
authors.forename: Stefan
authors.initials: S
authors.lastname: Seregard
authors.forename: Daniel
authors.initials: D
authors.lastname: Gologorsky
authors.forename: Amy C
authors.initials: AC
authors.lastname: Schefler
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Murray
authors.forename: Tero
authors.initials: T
authors.lastname: Kivelä
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Giuliari
authors.forename: Hugh
authors.initials: H
authors.lastname: McGowan
authors.forename: E Rand
authors.initials: ER
authors.lastname: Simpson
authors.forename: Christine
authors.initials: C
authors.lastname: Corriveau
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Coupland
authors.forename: Bertil E
authors.initials: BE
authors.lastname: Damato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003131:Combined Modality Therapy; D016208:Databases, Factual; D005127:Eye Color; D005260:Female; D006801:Humans; D038622:Internationality; D015811:Iris Neoplasms / Q000145:classification / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D008297:Male; D008545:Melanoma / Q000145:classification / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D008875:Middle Aged; D009367:Neoplasm Staging; D013508:Ophthalmologic Surgical Procedures; D011878:Radiotherapy; D012189:Retrospective Studies; D015996:Survival Rate; D014463:Ultrasonography; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult