Objective To describe the management of patients with occult anterior uveal melanomas presenting with extrascleral extension. Methods and analysis Retrospective case series including five patients with small pigmented nodular mass on the episclera. Each lesion was documented by slit-lamp photography and measured with high-frequency ultrasound imaging (ultrasound biomicroscopy). Diagnosis of uveal melanoma was confirmed by biopsy with lamellar sclerectomy. Immediate scleral patch graft repair was performed. Later, each tumour was treated with palladium-103 ophthalmic plaque brachytherapy. The mean plaque diameter was 12 mm (median, 12; range, 10–14). A mean apex prescription dose of 87 Gy (median, 84.5; range, 82.3–99.2) to a tumour depth of 2 mm from the inner sclera delivered over 7 continuous days. The main outcome measures were best-corrected visual acuity, changes in tumour and scleral characteristics and complications. Results During each surgery, residual tumour was visualised within an emissary passageway at the deep plane of scleral resection. At a mean of 80 months (median, 57; range, 24–159) follow-up, no patients experienced graft infection, scleromalacia or rejection. Biopsy was required to establish the diagnosis, transillumination failed, and therefore ultrasound measurements were used to determine the plaque size required to treat the relatively occult intraocular component. Despite these challenges, there were no cases of local tumour recurrence, secondary enucleation or metastatic disease. Attributed to cataract surgery, visual acuities improved in three patients and two were stable. Conclusion Extrascleral uveal melanoma extension can occur with undetectable, occult intraocular tumours. In these cases, plaque radiation effectively induced local tumour control, preserved vision and prevented metastasis. All data relevant to the study are included in the article or uploaded as supplementary information.

中文翻译：

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隐匿性前葡萄膜黑色素瘤表现为巩膜外扩展

目的 描述伴有巩膜外扩散的隐匿性前葡萄膜黑色素瘤患者的治疗。方法与分析回顾性病例系列，包括5例巩膜外层小色素结节性肿块患者。通过裂隙灯摄影记录每个病变，并通过高频超声成像（超声生物显微镜）进行测量。葡萄膜黑色素瘤的诊断通过板层巩膜切除术活检得到证实。立即进行巩膜补片移植修复。随后，每个肿瘤均采用钯 103 眼科斑块近距离放射治疗进行治疗。平均斑块直径为 12 毫米（中位数，12；范围，10-14）。连续 7 天对距内巩膜 2 mm 深度的肿瘤施加平均顶点处方剂量 87 Gy（中位值 84.5；范围 82.3-99.2）。主要结果指标是最佳矫正视力、肿瘤和巩膜特征的变化以及并发症。结果 在每次手术期间，在巩膜切除深平面的通道内可见残留肿瘤。在平均 80 个月（中位数为 57 个月；范围为 24-159 个月）的随访中，没有患者出现移植物感染、硬化软化或排斥反应。需要进行活检来确定诊断，但透照失败，因此使用超声测量来确定治疗相对隐匿的眼内成分所需的斑块大小。尽管存在这些挑战，但没有出现局部肿瘤复发、继发性剜除或转移性疾病的病例。由于白内障手术，三名患者的视力得到改善，两名患者的视力保持稳定。结论 无法检测到的隐匿性眼内肿瘤可能会发生巩膜外葡萄膜黑色素瘤扩散。在这些病例中，斑块放射有效地诱导局部肿瘤控制、保留视力并防止转移。与研究相关的所有数据都包含在文章中或作为补充信息上传。