Combined enucleation and orbitotomy for choroidal melanoma with orbital extension

Sir,

Extrascleral extension of uveal melanoma is observed in about 8% of cases and represents a poor prognostic factor.^{1, 2} Management of orbital melanoma is controversial. In general, small nodular extrascleral extensions noted incidentally on ultrasonography are managed by modifying enucleation so as to avoid transection of the area of involvement.³ Beneficial role of adjuvant radiotherapy in such cases remains questionable.³ Diffuse orbital involvement is best managed by exenteration, although long-term survival advantage offered by this procedure is not known.^{4, 5, 6, 7, 8} Larger but circumscribed orbital involvement may be excised via orbitotomy in conjunction with enucleation or proton beam radiotherapy.^{9, 10}

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