Mortality After Diagnosis of Small Melanocytic Lesions of the Choroid

Abstract

To evaluate the risk of dying of metastatic choroidal melanoma in patients with small, indeterminate, pigmented lesions of the uveal tract. Methods: A cohort of 1063 consecutive patients were evaluated in the Ocular Oncology Clinic of the Massachusetts Eye and Ear Infirmary between January 1976 and June 1996 with definite choroidal nevus (n = 256), indeterminate lesions (n=334), or small melanoma (n=373). Deaths occurring up to December 1998 were identified through active follow-up or by a search of the National Death Index. Cumulative death rates were compared among diagnostic groups using the Kaplan-Meier method. Results: Mean lesion diameter was 4.6 mm in the nevi, 7.0 mm in the indeterminate lesions, and 8.1 mm in the small melanomas. Patients ranged in age from 3 to 95 years (median, 64 years). A total of 15 deaths due to ocular melanoma were ascertained (median follow-up of survivors, 8.2 years), 13 in the melanoma group and 2 in the indeterminate lesion group; actuarial tumorspecific death rates at 10 years after evaluation were 5% (95% confidence interval, 3%-8%) and 1% (95% confidence interval 0%-3%), respectively. No deaths due to ocular melanoma occurred in the nevus group. Conclusions: These data document the very low malignant potential of most indeterminate melanocytic lesions of the choroid and support the current practice of monitoring these tumors, with treatment provided when growth and other signs of malignant transformation are observed.

Small metastasizing choroidal melanomas

“…Five patients (5.1%) died of metastasis after a median follow-up period of 51 months. Lane et al (2010) deaths occurred (median follow-up 8.2 years). Death rates for metastasis at 5, 10, 15 years were 2%, 5% and 7%, respectively.…”

Management of Uveal Melanoma: A Consensus-Based Provincial Clinical Practice Guideline

“…Furthermore, more recent work has found that, even after controlling for gep, tumour size (that is, basal dimension ≥ 12 mm) is an independent predictor of metastasis at 5 years 19 . In contrast, several small noncomparative case series have suggested that patients with small indeterminate lesions who are carefully selected by an ophthalmologist can be observed for tumour growth before treatment initiation without adversely affecting survival [43][44][45][46][47] . The American Brachytherapy Society guidelines suggest that patients being observed should be counselled about the small (yet still unquantified) increased risk of metastasis with observation 30 .…”

Small High-Risk Uveal Melanomas Have a Lower Mortality Rate

“…It has been assumed that larger UM are innately more aggressive, as they have either high-risk genetic factors from the outset or have accumulated these factors over time, termed ‘crescendo malignancy’ [ 67 ]. On this basis, it is conventional practice in many ocular oncology centers to monitor small, indeterminate uveal melanocytic tumors for months (or even years) until growth is documented [ 68 , 69 , 70 , 71 , 72 ]. Weis et al demonstrated that most of these indeterminate lesions are low-risk D3-UM [ 73 ].…”