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Progress and Hope: A Historical Perspective on the OM Field

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Progress and Hope: A Historical Perspective on the OM Field

  1. 1. Progress and Hope: A Historical Perspective on the OM Field Kenneth Hovland, MD Ocular Melanoma Patient and Caregiver Symposium Denver, Colorado April 20-22, 2018
  2. 2. 50 years ago:
  3. 3. • Removal of the eye was the only option
  4. 4. Positive attitude!
  5. 5. • Nationally, at the AFIP (1949-1970) there was a 20% error in diagnosis !
  6. 6. Indirect ophthalmoscope (1960’s)
  7. 7. Photography
  8. 8. Ultrasonography (1970’s)
  9. 9. B-scan A-scan
  10. 10. Radiation (1970’s) • Large dose needed
  11. 11. Radioactive Iodine125 Proton beam plaque
  12. 12. Collaborative Ocular Melanoma Study (COMS 1986-2003) For Medium tumors (2.5 to 10 mm thick) ?any survival advantage with: Iodine-125 plaque vs Enucleation
  13. 13. 1500 patients in 40+ centers
  14. 14. Iodine-125 plaque vs.Enucleation  Survival is equal  Quality of life issues
  15. 15. • Cobalt 60 • Iodine 125 • Palladium 103 • Ruthenium 106
  16. 16. • In patients with Large tumors (>10 mm thick) (requiring enucleation anyway), would pre-operative external radiation help survival? • Answer: No
  17. 17. COMS • Now 40 additional centers in US and Canada with expertise to diagnose and treat ocular melanoma • Accuracy: 99.7% (Only 1 benign tumor in 1500 cases)
  18. 18. Frequency of ocular melanoma (5-6 per million) • Unchanged for many decades, • Compared with definite increase of skin melanoma (> 20 times more common)
  19. 19. Optical Coherence Tomography (OCT)
  20. 20. Magnetic Resonance Imaging (MRI)
  21. 21. Positron Emission Tomography (PET)
  22. 22. • Genetic aspects
  23. 23. Skin melanoma is different than ocular melanoma Skin Eye
  24. 24. Team approach for patients: • Ophthalmic oncologist • Radiation oncologist, physicists • Ultrasonographers • Ophthalmic photographers • Medical oncologist • Genetic counselors • Social services
  25. 25. Basic research
  26. 26. • A lot of progress has been made in the diagnosis and management of ocular melanoma
  27. 27. Challenges  Earlier detection  Decrease side effects of radiation  Better treatment for metastases
  28. 28. Thanks to Dr. Sara Selig, with her own personal experience with ocular melanoma, for bringing together such a range of personnel to discuss these challenges, and for her tireless efforts to make progress in the lives of patients.

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