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V. Verma, M. H. Abdel-Rahman, C. M. Cebulla, F. H. Davidorf; Metastasis in Small Uveal Melanomas. Invest. Ophthalmol. Vis. Sci. 2010;51(13):874.
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© ARVO (1962-2015); The Authors (2016-present)
Small melanomas are not necessarily benign as was once thought. There is a need to identify the high risk characteristics for metastasis in all uveal melanomas including small tumors. We studied the patient and tumor characteristics of small uveal melanomas in patients that developed metastatic disease.
Patients at OSU diagnosed with small uveal melanoma (T1, N0, M0) who later developed metastasis were drawn from our database of records (enrolled 2006 -Present) collected with an IRB approved protocol. Data collected included tumor dimensions, clinical high risk characteristics, patient age, pathology, time from initial diagnosis to diagnosis of metastasis, type and date of treatments, local recurrence, and post-mortem analysis.
5 of 124 (4 %) patients with small melanomas were found to have metastatic disease. All patients were examined and treated by the same physician. Average patient age at diagnosis was 54.6 yrs (range 46-76). The average size tumor height at diagnosis was 1.84 mm (range 1.0-2.4) with average largest basal dimension 8.1mm (range 5 - 10mm). All patients were treated prior to diagnosis of metastasis. The most common treatment was primary TTT (4/5) with multiple treatments, followed by brachytherapy (1/5). Secondary treatments included enucleation (1/5), PDT (1/5), and argon laser photocoagulation (1/5). Local recurrence after initial therapy was found in all 5 patients. The average choroidal tumor height increased with time and measured 2.52 mm (range 1-3.2mm) upon diagnosis of metastasis. Metastasis involved the liver in 4/5 patients and the lung in 2/5 patients. Cell type was spindle cell in 2/5 and unknown cell type in 3/5. Time from ocular diagnosis to metastasis on average was 7.4 years (range 1-19). 3/5 patients are deceased secondary to metastatic disease with time from diagnosis of metastasis to death being 1.3 years (range 1-3) and the 2/5 living patients were diagnosed with metastasis 0 and 2 years ago.
Small uveal melanomas have the potential for metastasis which carries with it significant mortality risk. There were a few unifying factors for small choroidal melanomas that metastasized, including local recurrence and tumor growth despite multiple treatments. The patients in our series had a wide age range and a variable time to metastasis, which underscores the importance of regular and long term follow up for patients with small choroidal melanoma.
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