gms | German Medical Science

Background: Size of choroidal melanoma correlates statistically with histological grade of malignancy, prevalence of monosomy 3 and metastatic mortality. These findings support the hypothesis that delayed treatment allows uveal melanomas to become progressively more malignant with time and growth, eventually developing metastatic capability and metastasizing. According to this hypothesis, early treatment of uveal melanomas prevents de-differentiation and metastasis of uveal melanomas, whereas recurrent ocular tumour is life-threatening. This hypothesis encourages early and aggressive ocular treatment.

Methods: A series of 3393 patients with uveal melanoma were followed up. Date and cause of death were notified to us by the Cancer Registry of the National Health Service.

Results: The 20-year mortality rates correlated closely with the incidence of monosomy 3. This finding suggests that metastatic disease occurred almost exclusively in patients with monosomy 3 melanoma, all of which were fatal despite ocular treatment.

Conclusions: The main conclusions are that ocular treatment of uveal does not influence survival and should be regarded as either symptomatic or palliative. The main objectives of ocular treatment should therefore be to conserve the eye and useful vison, not to prolong life. Concerns about trans-scleral and trans-retinal local resection are exaggerated. The best hopes for prolonging life are with systemic adjuvant therapy. All patients with uveal melanoma should routinely have genomic tumour typing for proper prognostication and to enhance prospects for improving survival.