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Ariane Malcles, Anh-Minh Nguyen, Laurent Kodjikian, Philippe Denis, Jean-Daniel Grange; Small metastasizing choroidal melanomas: Report of 6 cases. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5083.
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© ARVO (1962-2015); The Authors (2016-present)
Small choroidal melanomas have a better prognosis than large tumors. However these small tumors can spread, often late in their course.The aim of the study was to analyse survival and tumor characteristics of 6 cases of late metastatic diseases after conservative treatment.
A retrospective study was conducted among 523 patients treated between 1991 and 2010 by proton beam therapy (508) or brachytherapy with 106 Ru/Rh (15) for uveal melanomas. We have selected patients with small choroidal melanoma (thickness ≤ 3 mm and diameter ≤ 9 mm) (59 patients), who have developed liver metastases (6 out of 59). All tumors were classified T1a at the time of diagnosis (according to the 7th edition of the TNM stagging system).
At the time of diagnosis, median age was 57 years (range, 37-82 years). Four patients had visual symptoms (blurred vision, metamorphopsia, floaters). The mean tumor thickness was 2.9 mm (range 2.5mm - 3mm) and the mean diameter was 7 mm (5mm-8mm). Orange pigment was observed in 4 cases, subretinal fluid in 2 cases, and one tumor touched the optic disc. Five patients had proton beam therapy. One patient had beta brachytherapy (106 Ru/106 Rh). Average follow-up was 8.3 years (range 4.2 to 11.8 years). Local ocular tumor control was excellent, none tumor recurred after local treatment. The mean survival time after diagnosis of melanoma was 9.8 years (range, 4.9-14.6 years). The average time from treatment of primary tumor to detection of liver metastasis was 7 years (range 3.9 to 12 years). The mean survival time from the diagnosis of metastasis was 35,2 months (range 9 to 101 months). Small melanoma-related death was 0% at 3 years, 1.7% at 5 years, 5.1% at 10 years, and 10.2% at 15 years in our series.
Despite a small tumoral size and an early and effective local treatment 6 out of 59 small choroidal melanomas have developed metastasis several years after local treatment. Small tumors represent a significant risk of metastasis.
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