Iris Melanoma: Review of Clinical Features, Risks, Management and Outcomes.

Primary uveal melanoma is rare and affects approximately 8,000 persons per year worldwide. This malignancy can involve the iris, ciliary body, and choroid. Of these three structures, the iris is the least commonly affected site, representing only 4% of all uveal melanomas. Iris melanoma can arise from iris melanocytic nevus, iris melanocytosis, or de novo. In a longitudinal study of 1,611 patients followed with iris nevus, transformation into melanoma, using Kaplan-Meier estimates, was found in 2.6% by 5 years and 4.1% by 10 years. The factors that predicted growth of iris melanocytic nevus into melanoma are remembered by a lettering (ABCDEF) guide that represents A for Age ≤40 years old at presentation (HR=3, p=0.01), B for Blood (hyphema) (HR=9, p<0.0004), C for Clock hour of tumor inferiorly (tumor location) (HR=9, p=0.03), D for Diffuse flat tumor configuration (HR=14, p=0.02), E for Ectropion uveae (HR=4, p=0.002), and F for Feathery ill-defined margins (HR=3, p=0.02). At diagnosis, iris melanoma demonstrates clinical features of mean cross-sectional diameter of 5.5 mm and thickness of 2.1 mm, often with tumor seeding (28%) and secondary glaucoma (35%). Herein, we provide a comprehensive review of iris nevus and melanoma to explore relevant demographic and clinical data, risk factors for tumor growth, management, and prognosis with the hope that clinicians will be more comfortable in understanding this rare malignant condition.