Amelanotic Uveal Melanomas Evaluated by Indirect Ophthalmoscopy Reveal Better Long-Term Prognosis Than Pigmented Primary Tumours—A Single Centre Experience

Abstract

(1) Background: There is a constant search for new prognostic factors that would allow us to accurately determine the prognosis, select the type of treatment, and monitor the patient diagnosed with uveal melanoma in a minimally invasive and easily accessible way. Therefore, we decided to evaluate the prognostic role of its pigmentation in a clinical assessment. (2) Methods: The pigmentation of 154 uveal melanomas was assessed by indirect ophthalmoscopy. Two groups of tumours were identified: amelanotic and pigmented. The statistical relationships between these two groups and clinical, pathological parameters and the long-term survival rate were analyzed. (3) Results: There were 16.9% amelanotic tumours among all and they occurred in younger patients (p = 0.022). In pigmented melanomas, unfavourable prognostic features such as: epithelioid cells (p = 0.0013), extrascleral extension (p = 0.027), macronucleoli (p = 0.0065), and the absence of BAP1 expression (p = 0.029) were statistically more frequently observed. Kaplan–Meier analysis demonstrated significantly better overall (p = 0.017) and disease-free (p < 0.001) survival rates for patients with amelanotic tumours. However, this relationship was statistically significant for lower stage tumours (AJCC stage II), and was not present in larger and more advanced stages (AJCC stage III). (4) Conclusions: The results obtained suggested that the presence of pigmentation in uveal melanoma by indirect ophthalmoscopy was associated with a worse prognosis, compared to amelanotic lesions. These findings could be useful in the choice of therapeutic and follow-up options in the future.

Quantitative Diffusion-Weighted MR Imaging: Is There a Prognostic Role in Noninvasively Predicting the Histopathologic Type of Uveal Melanomas?

“…A biopsy is not routinely performed for diagnostic purposes [5,6]; however, it can be used in the case of lesions with atypical appearance and, above all, for prognostication [7][8][9][10][11][12]. In the last few decades, a wide variety of prognostic parameters have been detected and investigated: tumor location and dimensions, histologic type, mitotic count, pigmentation, infiltrating lymphocytes and genetic alterations [13][14][15][16]. As for histopathologic features, UM encompasses three histopathological subtypes: epithelioid cell type, spindle cell type and mixed type, accounting for approximately 3-5%, 40% and 50% of all UMs, respectively [17,18].…”

Magnetic Resonance Imaging in the Clinical Care for Uveal Melanoma Patients—A Systematic Review from an Ophthalmic Perspective

“…For example, although UM are commonly hyperintense on T1 due to their pigmentation, making this an important clue in the differential diagnosis, melanocytomas are also hyperintense on T1. Furthermore, as approximately 15% of UM are unpigmented [28,127,128], the lack of T1-hyperintensity alone is not sufficient to exclude UM from the differential diagnosis. As a result, an MRbased diagnosis without inclusion of functional scans has been reported to be inconclusive for teratocarcinosarcoma [129], malignant rhabdoid tumour [130], leiomyoma [131,132], lymphoma [133] and intraocular metastasis [75,94].…”

Locally advanced choroidal melanoma with favorable molecular prognosis – case report

“…Amelanotic uveal melanomas are associated to favorable prognosis compared to pigmented uveal melanomas. This comes in contrast to amelanotic melanomas of other sites, which have a less favorable prognosis than pigmented lesions [ 12 ].…”