Abstract
Purpose :
To describe the clinical features and outcomes in young patients with uveal melanoma (UM) from a large referral center in the mid-south United States.
Methods :
A retrospective review of patients less than 31 years of age at UM diagnosis from the University of Tennessee Hamilton Eye Institute from 1985 to 2015 was performed. Patient demographics, tumor characteristics, treatment complications, and final outcomes were recorded. Primary outcomes included overall event and metastasis free survival, and globe salvage rates.
Results :
Forty-three patients were identified from a database of 1,572 UM patients, 32 of which were included. Mean age at the time of surgery was 23.9 ± 5.8 with 56.3% males. Mean baseline LogMar BCVA was 0.78 ± 0.72. Tumor staging was: 12.5% T1a, 37.5% T2a, 15.6% T3a, 9.4% T3b, 6.3% T4a, and 18.8% T4b. Mean baseline tumor measurements were apical thickness (AT) 7.1 mm ± 3.4, largest basal diameter (LBD) 14.2 mm ± 4.1, and volume (V) 435.5 mm3 ± 415.6. All patients underwent primary iodine-125 plaque brachytherapy. Final mean BCVA LogMar was 1.72 ± 1.19. Only 2 patients had gene expression profiling (GEP) performed. The first patient was stage T2a GEP 1a, PRAME (+) with no metastasis at 160 months. The second was stage T4b, GEP class 2 tumor and was metastasis-free at year 3 but was lost to follow-up. Final mean tumor measurements were AT 3.9 mm ± 2.9, LBD 8.6 mm ± 5.0, and V 128.7 mm ± 150.4. Radiation retinopathy (RR) occurred in 53.1%. The mean follow-up was 102.1 months ± 70.1. Three patients developed recurrence (9.4%) and 6 underwent enucleation (18.8%). Metastasis occurred in four patients (12.5%). At last follow up, 84.4% were alive without metastasis, 3.1% alive with metastasis, 6.3% deceased due to metastasis, and 6.3% deceased due to an unknown cause. Of 13 patients who were followed for more than 10 years, 23% developed metastases (1 liver, 2 multifocal), and 2 died secondary to metastasis.
Conclusions :
Young adults with UM may have more favorable outcomes compared to older adults. Higher baseline tumor measurements were associated with poorer overall event and metastasis-free survival. RR was the most frequent treatment complication. Longer follow-up is needed to improve care in younger patients with UM.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.