Clinical parameters predictive of enlargement of melanocytic choroidal lesions.

Abstract

SUMMARY The authors followed up 197 melanotic choroidal lesions (62 categorised as benign naevi, 76 classified as suspicious naevi, 41 diagnosed as dormant melanomas, and 18 categorised as active melanomas) left untreated after their initial clinical documentation. Thirty-nine of these lesions enlarged during a five-year follow-up interval (cumulative proportion of lesions that enlarged=26-2% by Kaplan-Meier method). Individual clinical parameters predictive of lesion enlargement (p<OOl) included larger size of the lesion, especially lesion thickness, presence of retinal detachment, location of the lesion's posterior margin within 2 disc diameters of the optic disc, presence of symptoms, and presence of orange pigment clumps on the lesion's surface. The best combination of these parameters for prediction of lesion enlargement, as identified by multivariate Cox regression analysis, consisted of thickness of the lesion, retinal detachment, and symptoms. The five-year incidence of lesion enlargement for patients with none of these prognostic parameters was 5-8%, while that for patients with all three unfavourable parameters simultaneously was 90*6%.

Risk Factors for Growth and Metastasis of Small Choroidal Melanocytic Lesions

“…A prior study from our department found that tumors located closer to the optic disc had a greater tendency to demonstrate growth; however, metastases was not included as an outcome measure. 24 Choroidal melanomas that show clinical evidence of growth have an increased mitotic activity histopathologically when compared with nongrowing tumors.4' Mitotic activity has long been associated with malignant potential.3 We found in our study that documented tumor growth carried a substantial relative risk of 7.6 for development of metastases as compared with nongrowing lesions. Because ofthe prominent risk for metastases in growing tumors, we sought to identify the factors that predicted tumor growth.…”

“…[23][24][25][26] Most recently, Butler and coworkers26 studied "indeterminate" pigmented choroidal tumors and identified risk factors for tumor enlargement, including greater tumor thickness, symptoms, orange pigment, internal quiet zone on B-scan ultrasonography, and hot spots of fluorescein angiography. Of the 195 tumors in their series without documented growth, there were no metastases, and of the 98 tumors demonstrating growth, 5% developed metastases.…”

“…Our study represents by far the largest and most inclusive study of this type: we have reviewed 1,329 choroidal melanocytic tumors ranging from flat lesions to those up to 3 mm in thickness, regardless ofartificial classifications such as nonsuspicious or suspicious choroidal nevus, indeterminate choroidal tumor, nevoma, or active or dormant choroidal melanoma. [23][24][25][26] …”

Termoterapia transpupilar em melanoma maligno da coróide

“…Esta forma de raciocínio, entretanto é contrária à filosofia aplicada para os cânceres em geral que preconiza o diagnóstico e tratamento precoce com intuito de aumentar a sobrevida dos pacientes. O curso natural destas pequenas lesões melanocíticas da coróide vem sendo estudado e fatores preditivos de crescimento vêm sendo definidos, porém atualmente, mais do que a preocupação com o crescimento destas lesões, estudos vem sendo conduzidos com o objetivo de definir seu potencial de desenvolver doença metastática e morte (11)(12)(13)(14)(15)(16) . Diener-West e col. encontraram uma taxa de mortalidade de 16% em 5 anos para portadores de tumores da coróide classificados como pequenos, e demonstraram que indivíduos com melanomas da coróide pequenos apresentam um risco de óbito 1,3 vezes maior quando comparados à população geral (13) .…”

Assessment of indeterminate melanocytic choroidal tumours with optical coherence tomography: A cohort study

“…This difficult situation is rather different from that of medium-sized and large melanomas, which can be diagnosed correctly in more than 99% of cases [2] . Clinical features predictive of tumour growth were described over twenty years ago and include: tumour thickness exceeding 2 mm; confluent orange pigment; serous retinal detachment; symptoms (blurred vision or loss of peripheral vision, floaters or flashing lights); and contact with optic disc [3,4] . The likelihood of tumour growth is related to the number of such risk factors that are present.…”