title: EXTRAOCULAR EXTENSION OF CILIOCHOROIDAL MELANOMA AFTER TRANSSCLERAL FINE-NEEDLE ASPIRATION BIOPSY.
abstract: OBJECTIVE
  To describe development of extraocular extension of ciliochoroidal melanoma after transscleral fine-needle aspiration biopsy (FNAB) for cytogenetic studies.
  
  
  METHODS
  Transscleral FNAB was performed for cytogenetic analysis of melanoma using a long 27-gauge needle attached to a 10-mL syringe by connector tubing entering obliquely through the sclera overlying the tumor base. An iodine 125 radioactive plaque was immediately applied to the sclera over the tumor and biopsy site after FNAB.
  
  
  METHODS
  One patient with large ciliochoroidal melanoma of the right eye.
  
  
  RESULTS
  Cytogenetic analysis of the melanoma revealed monosomy of chromosome 3. On examination, 18 months after plaque radiotherapy, there was regression of the tumor; however, a few small subepithelial pigmented lesions were noted in the conjunctiva close to the FNAB site. Excisional biopsy of the conjunctival pigmented lesions with 3 mm margins and with supplemental cryotherapy to the surrounding conjunctival margins and to the underlying sclera was performed. Histopathologic evaluation showed an oval nodule composed of a mixture of spindle and epithelioid cells deep within the substantia propria consistent with extraocular extension of uveal melanoma. Magnetic resonance imaging of the orbits showed no evidence of orbital involvement. This is the only case of extraocular extension developing among 408 consecutive transscleral biopsies (0.2%) performed at our center for cytogenetic or cytopathologic analysis.
  
  
  CONCLUSIONS
  Although rare, transscleral FNAB of ciliochoroidal melanoma can lead to extraocular extension of the tumor through the biopsy site. Possible techniques to reduce the risk of this problem are discussed.
authors.affiliation: *Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania; and †Department of Pathology, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Arman
authors.initials: A
authors.lastname: Mashayekhi
authors.forename: Renelle P
authors.initials: RP
authors.lastname: Lim
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
authors.forename: Ralph C
authors.initials: RC
authors.lastname: Eagle
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Shields
mesh_terms: D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D002830:Choroid Neoplasms / Q000473:pathology*; D003230:Conjunctival Neoplasms / Q000473:pathology*; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology*; D009366:Neoplasm Seeding; D014604:Uveal Neoplasms / Q000473:pathology*; D000098943:Uveal Melanoma