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U. S. Rao, A. Lin, D. Shetlar; Incidence of Primary Ocular Melanoma in Patients With Newly Diagnosed Primary Cutaneous Malignant Melanoma Referred to a Large VA Medical Center Ophthalmology Clinic for Ocular Melanoma Screening. Invest. Ophthalmol. Vis. Sci. 2010;51(13):878.
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The occurrence of primary ocular melanoma in patients diagnosed with primary cutaneous malignant melanoma has only been seen in isolated cases. However, patients with newly diagnosed cutaneous malignant melanoma are routinely referred to the Houston VAMC Ophthalmology Clinic for ocular melanoma screening. There are no absolute guidelines as to whether these referrals are warranted, and there has been no retrospective study to date evaluating the effectiveness of these screenings. The purpose of this study is to determine the incidence of ocular melanoma and other significant eye conditions requiring follow-up in patients with newly diagnosed primary cutaneous malignant melanoma referred to the Houston VAMC Ophthalmology Clinic for ocular melanoma screening.
1422 patient charts from the Houston VAMC were reviewed based on ICD-9 codes representing malignant neoplasm of the skin in various anatomical locations used during all physician encounters between January 2003 and December 2007.
Based on this chart review, 57 patients with newly diagnosed, biopsy proven cutaneous malignant melanoma were referred to and seen in the VAMC ophthalmology clinic for ocular melanoma screening. No patients were found to have ocular melanoma. 31 patients were established patients of the eye clinic and no new incidental diagnoses were made at the screening visit. Out of the 26 new patients, 9 patients were diagnosed with ocular conditions requiring follow-up including dry ARMD, primary open angle glaucoma suspect/ ocular hypertension, lattice degeneration, hollenhorst plaque with no significant carotid stenosis, and small choroidal nevus.
The results of this study suggest that it is not cost effective for all patients with newly diagnosed primary cutaneous malignant melanoma to undergo routine ophthalmic screening. Prior studies suggest ophthalmic screening is only effective for those patients with a strong personal or family history of an atypical nevus syndrome. A new database search using additional ICD-9 codes used for malignant melanoma within the time period specified by this study resulted in several thousand additional physician-patient encounters. These patient charts are currently being reviewed and this data will be presented.
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