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ICD 10 code for Malignant neoplasm of unspecified site of unspecified eye. Get free rules, notes, crosswalks, synonyms, history for ICD-10 code C69.90.
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What is uveal melanoma?
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C69.40 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2024 edition of ICD-10-CM C69.40 became effective on October 1, 2023. This is the American ICD-10-CM version of C69.40 - other international versions of ICD-10 C69.40 may differ.
- Disease Entity
- Diagnosis
- Management
- Local Therapy to The Eye
- Treatment of Metastatic Disease
- Complications
- Prognosis
- Historical Perspectives
- Additional Resources
Diease
Uveal melanoma is a malignant tumor arising from melanocytes in the uveal tract (iris, ciliary body, or choroid). It is the most common primary intraocular tumor in adults with an age-adjusted incidence of 5.1 per million. There is a strong tendency for metastasis, particularly to the liver, and prognosis is poor when the tumor has disseminated. The choroid is the most common site involved and gives rise to 90% of uveal melanomas. Melanomas arising within the ciliary body comprise 7% and mela...
Risk Factors
While development of uveal melanoma is largely considered to be a sporadic event, certain risk factors including light iris color, light skin color, ability to tan, northern European ancestry, and rarely a family history of uveal melanoma may predispose individuals to the disease.Those with pre-existing choroidal nevi are also at risk where the incidence of malignant transformation for each lesion is 1/5000 to 1/8845.
Pathophysiology
Uveal melanomas develop from the unregulated clonal proliferation of uveal melanocytes. As with other malignancies, this results from a complex sequence of molecular events involving multiple driver mutations in different genes. Five genes are most commonly implicated in the tumorigenesis of uveal melanoma: GNAQ, GNA11, BAP1, SF3B1, and EIF1AX. Somatic mutations in either GNAQ or GNA11 are found in 83% to 89% of uveal melanomas and occur exclusive to one another. Mutations involving these gen...
Symptoms
The clinical presentation of malignant uveal melanoma is characterized by nonspecific findings associated with the location of the tumor. Approximately 30% of patients are asymptomatic at presentation. 38% complain of decreased vision, 9% report photopsias, 7% floaters and 6% peripheral vision loss. Only 2% of patients complain of eye pain. Very rarely an advanced case of iris melanomamay present with a secondary glaucoma due to tumor extension into the angle and pigment-laden macrophages cau...
Diagnostic Imaging
Serial fundus photos are critical in the follow up of choroidal nevi and melanoma. The widefield retinal (WFR) imaging such as Optos creates an easily replicated map of the fundus. Certain WFR imaging systems distort the color of the tumor and fundus.
Depending upon several clinical factors, management options today include observation, radiation, laser, surgery, medical management, or a combination of these approaches. The selected management depends on size, thickness, location, and activity of the tumor, the status of the opposite eye, and the age, general health, and psychological status of ...
Surgery
There are several methods for surgical management of posterior uveal melanoma including enucleation, exenteration, and local resection.
Radiotherapy
Presently, radiotherapy is the most widely employed intervention for posterior uveal melanoma. However, between 5% and 10% of patients treated with radiotherapy ultimately require enucleation of the affected eye because of tumor recurrence or radiation complications (e.g. neovascular glaucoma, radiation retinopathy, radiation optic neuropathy).Radiation tumor vasculopathy is also common as the irradiated tumor can become ischemic, resulting in macular edema, serous retinal detachment, retinal...
Laser therapies
Laser therapies include photocoagulation, transpupillary thermotherapy, and photodynamic therapy. Sometimes lasers are used as adjuncts to brachytherapy. They are rarely used as primary intervention due to the unacceptably high rate of incomplete control, tumor recurrence and extrascleral extension.Lasers are best used as treatment for radiation induced side effects such as retinal detachment, radiation retinopathy and neovascular glaucoma.
Ideally, the best management of uveal melanoma would be to use methods of preventing metastasis in the early stages of the intraocular disease. Unfortunately, there is no current method of achieving this. Nearly half of all patients with uveal melanoma will develop metastatic disease. Uveal melanoma spreads exclusively hematogenously, unless it bec...
As radiotherapy is the most commonly used treatment option, the main ocular complication following radiotherapy is retinopathy with resultant decreased visual acuity. Gunduz and associates studied retinopathy following plaque radiotherapy and noted nonproliferative retinopathy in 42% at 5 years and proliferative retinopathy in 8% at 5 years.Other r...
The prognosis for uveal melanoma should be considered in terms of life, the globe, and visual acuity. With regards to life prognosis, uveal melanoma prognosis has been shown to be dependent on several clinical factors including tumor location in the ciliary body, large tumor size, diffuse (flat) configuration, and extraocular extension as well as h...
In 1809, the first known complete natural history of uveal melanoma was documented by Scottish surgeons Allan Burns and James Wardrop. In 1882, Ernst Fuchs was the first to describe sarcom des uvealtractus(“uveal sarcoma,” now known as uveal melanoma) as “one of the most malignant of diseases” and recommended enucleation as the treatment of choice ...
Shields JA, Shields CL. Intraocular Tumors: A Text and Atlas. Philadelphia: WB Saunders, 1992.Shields JA, Shields CL. Intraocular Tumors. An Atlas and Textbook. 2nd edition. Philadelphia, Lippincott Williams and Wilkins, 2008.www.fighteyecancer.comwww.choroidalmelanoma.comAug 9, 2022 · Eye melanoma is a type of eye cancer. Learn about symptoms and treatments for this rare cancer. It's also called ocular melanoma or uveal melanoma.
Uveal melanoma is a type of eye cancer in the uvea of the eye. [3] It is traditionally classed as originating in the iris, choroid, and ciliary body, but can also be divided into class I (low metastatic risk) and class II (high metastatic risk). [3]
Oct 11, 2021 · Uveal melanoma is a rare condition accounting for only 5% of all primary melanoma cases. Still, it is the most frequently diagnosed primary intraocular malignant tumor in adults. Almost 90% of the tumors involve the choroid and only a small percentage affects the ciliary body or the iris.
Uveal melanoma is a rare cancer but the most frequent noncutaneous melanoma and primary malignancy of the eye in adults. Worldwide, it is estimated that there are 7095 new cases of uveal melanoma annually with a mean age-adjusted incidence of 4.3 per million ( 1, 2 ).
