A 51-year-old woman was found to have a small, pinkish tumor of the left iris The visual acuity was not affected, and the intraocular pressure was normal. A tumor of the iris can be a manifestation of metastatic disease, with a differential diagnosis including amelanotic melanoma and peripheral anterior synechiae. Whole-body computed tomography of the patient revealed a retroperitoneal tumor with erosion of the right ilium and multiple pulmonary lesions that were suggestive of metastases. A gynecologic examination revealed an endometrioid adenocarcinoma of the uterus, histologically identified as having a low level of differentiation, with a local vaginal metastasis. The pulmonary lesions were regarded as metastases of this primary tumor. We proposed to perform primary radiotherapy of the pelvis, followed by chemotherapy, but the patient declined treatment. In the absence of an acute eye-threatening condition and because of the patient's very poor overall prognosis, the iris tumor was not removed. One month later, no change in the appearance of the iris tumor was seen. The patient did not present for further gynecologic or ophthalmologic follow-up.
How do you counsel this patient using spike protocols ?
