Treatment of retinoblastoma and choroidal melanoma. A multidisciplinary approach.

Retinoblastoma and choroidal melanoma are two malignant ocular tumours that still give rise to discussions about diagnosis, natural history with respect to metastasis an choice of treatment. The therapeutic problems are best solved within a multidisciplinary oncology team in which the ophthalmologist, ophthalmopathologist and the general pathologist play an important role. In most institutes for ophthalmology a patient with a tumour in or in the region of the eye, is first seen by a specialist for eye diseases, who is also a surgeon in this field. In general the ophthalmologist decides on the diagnosis, the treatment and the follow-up without consulting other specialists in oncology. This solely ophthalmological approach can harbour a potential danger for the patient. Decisions on treatment made in a multidisciplinary team of specialists trained in oncological principles are responsible for the best results. Surgery combined with radiotherapy and chemotherapy can be a better choice than surgery alone, but even when surgery alone seems the best treatment, the discussion with the members of an oncological team can be of importance for the surgeon. The natural history of the tumour which includes the growth patterns, the growth rate and the tendency to metastasize may influence the choice of the surgical procedure; surgical intervention might be more or less extensive than previously foreseen. Dr. W.A. Manschot, professor in ophthalmic pathology, rightly advocates the contribution of the ophthalmopathologist to such an oncological team, because such a person has acquired knowledge in histopathology of the ocular tumours and experience in evaluating international literature in this field, the results of the treatment of groups of patients with the same tumour and publishing the statistically verified conclusions.(ABSTRACT TRUNCATED AT 250 WORDS)