Choroidal and ciliary body melanomas are potentially blinding and lethal. Currently, the only clinical guide to the likelihood of these tumors disseminating is the location of the tumor within the eye and the largest dimension of the tumor in contact with the sclera. It is not possible to perform incisional biopsies on these tumors without inflicting significant visual morbidity. Unfortunately, fine-needle aspiration biopsies do not yield material that is adequate for prognostication. There is a need for a clinical non-invasive technique to grade the likely aggressiveness of a tumor in vivo. The general goal of this proposed research is to improve the management of patient with ciliary body and choroidal melanomas by characterizing the microcirculation of these tumors. New morphological technique, including laser scanning confocal microscopy, will be used in two ways; (a) to describe and categorize the vascular patterns that appear in choroidal and ciliary body melanocytic neoplasms by their biological behavior (nevi and primary ciliary body and choroidal melanomas that do and do not disseminate) and (b) to determine the relationship between prognosis and the distribution and density of these vessels in two and three dimensions. Therefore, it should be possible to identify ciliary body and choroidal melanomas at high risk for dissemination on the basis of tumor vascular morphology, location, or density. Ultrasound tissue characterization is a non-invasive ultrasonographic technique which identifies microregions in tumors rather than individuals cell types. Evidence suggests that these microregions, identified b ultrasonographic backscatter patterns, are small packets of tumor cells that are delimited by tumor blood vessels. Therefore, the final specific aim of this proposal is to correlate ultrasonographic tissue characterization data with studies on the biological significance of morphology, location and density of tumor blood vessels. If acoustic tissue typing can identify prognostically significant information about the microcirculation of ciliary body and choroidal melanomas, ophthalmologists would have a clinically useful, non-invasive method to assess the biological behavior of these tumors.
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