Purchase this article with an account.
N. Trichopoulos, J.J. Augsburger; Do Clinically Identified Invasive Features of Small Choroidal Melanomas Predict an Increased Probability of Death from Metastatic Disease? . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4969.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: To determine if clinically identified invasive features of small choroidal melanomas predict an increased risk of death from metastatic disease. Methods: Retrospective comparative survival study of 149 patients having a small choroidal melanoma (largest basal diameter ≤ 10 mm, thickness ≤ 3 mm) treated from 1980-1999. Clinical records were evaluated to identify presence or absence of clinical features of the tumors at pretreatment ophthalmic examination. Features regarded as invasive included eruption of tumor through Bruch’s membrane, retinal, optic disc or scleral invasion, and subretinal or intravitreal hemorrhage secondary to tumor. Patients were divided into the following subgroups prior to data analysis: subgroup 1: patients whose tumor showed no invasive clinical features, had no documented growth, and had ≤ 1 prognostic factor for growth [thickness >1.5 mm, clumps of orange pigment on tumor surface, serous subretinal fluid over and around tumor] (n = 5); subgroup 2: patients whose tumor showed no invasive clinical features and no documented growth but had ≥ 2 prognostic factors for growth (n = 43); subgroup 3: patients whose tumor exhibited documented growth during pretreatment follow-up but no invasive clinical features (n = 63); and subgroup 4: patients whose tumor exhibited invasive clinical features (n = 38). Because of its small size, subgroup 1 was excluded prior to data analysis. Because of similarities between subgroups 2 and 3, they were combined for comparison with subgroup 4 in data analysis. The principal outcome evaluated was death from metastasis. Results: Combined subgroups 2 and 3 (noninvasive subgroup) and subgroup 4 (invasive subgroup) were well matched in terms of baseline demographic and tumor features. 25 patients had died prior to the date of data analysis, 17 in the noninvasive (10 from metastasis) and 8 in the invasive subgroup (5 from metastasis). Survival analysis based on deaths from metastasis yielded five and ten-year cumulative survival probabilities of 93.5% and 80.6% in the invasive subgroup versus 94.6% and 90.5% in the non-invasive subgroup (P = 0.40, log rank test). Conclusions: Although differences in survival curves between patients with small choroidal melanomas with and without invasive clinical features were not significantly different in this small retrospective study, the rate of death from metastasis was substantially higher in the invasive subgroup. This finding suggests that clinically identified invasive features of small choroidal melanomas may be useful for refining survival prognostication for such patients.
This PDF is available to Subscribers Only