## 4 Treatment and Management  
### Surgical Excision  
As many primary iris lesions have a benign prognosis, many authors tend to manage smaller iris tumors (less than 3 mm basal diameter) in a conservative way [9]. However, the treatment of choice for growing lesions has typically been excision, while advances in microsurgical techniques and equipment have allowed more accurate tumor resection with fewer complications and less trauma to the eye. If the tumor is localized in the iris with no extension to the iris roots or seeding, [PERSON] et al. suggested a partial lamellar scleroidectomy with a scleral flap incision to reduce postoperative astigmatism, and a wide limbal incision (five or more clock hours) to prevent cancer cells from touching surrounding tissues, according to the \"no touch\" technique; that is, without handling the tumor tissue directly [17]. It is essential to resect at least 1 to 2 mm of safety margins [17]. In cases of confined tumors with iris root invasion but with no seeding, a partial lamellar iridocyclectomy with a more posterior scleral flap, large incision and excision of the entire iris mass surrounded by the normal iris and ciliary body may be preferable [17]. Serious management problems arise when the seeding of the tumor occurs on the contiguous iris or in the angle, as well as at a distance on the lens or on the corneal endothelium [17]. When seeding from iris melanoma is diffuse, the ophthalmic surgeon is advised to perform enucleation after cytologically confirming the diagnosis (FNAB) or, in special circumstances, using plaque radiotherapy [17]. However, if the seeding is confined to a size of within one or two clock hours of the tumor, the careful removal of the whole mass and seeding is executed, usually followed by the insertion of a radioactive plaque to the resection site [17]. In the literature, complications following iris melanoma resection include hemorrhage, vitreous loss, dislocated lens, iridocyclitis, macular edema, secondary glaucoma, retinal detachment and cataract. The rate of vitreous loss, hemorrhage and macular edema is low [8]. Other disadvantages arise from the large opening of the iris, such as diplopia, photophobia, sensation of glare and cosmetic alteration of the iris. Although good visual acuity can be provided with spectacle correction, the best correction method remains the use of a toric, rigid gas-permeable contact lens; in particular, lenses including an artificial pupil [9].  
Compared with radiotherapy, surgical resection shows advantages such as tumor removal, minimal cataract and a lack of radiotherapy-induced side effects [1]. The incidence of recurrence and metastases is similar for all procedures. In a comparison between radiotherapeutic and surgical treatment of iris melanoma, [PERSON] and [PERSON] state that tumor resection presents a higher risk of complications (hemorrhage and endophthalmitis) than plaque radiotherapy, which is an external procedure [31].  
[PERSON] et al. assert that smaller tumors (diameter \(<\)5 mm) are more likely to be managed by surgery alone and that larger tumors (diameter \(\geq\)5 mm) are more likely to be managed by radiotherapy [20].