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October 1993

Impact of Delayed Treatment in Growing Posterior Uveal Melanomas

Author Affiliations

From the Oncology Unit, Retina Service, Wills Eye Hospital—Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pa. Dr Vrabec is now with the Department of Ophthalmology, Geisinger Medical Center, Danville, Pa.

Arch Ophthalmol. 1993;111(10):1382-1386. doi:10.1001/archopht.1993.01090100090033

Objective:  To investigate the impact of pretreatment tumor growth on survival in patients with primary posterior uveal melanoma.

Design:  Retrospective case-by-case matched comparative survival study.

Patients:  Thirty patients with documented tumor growth of at least 3 mm in basal diameter, 1.5 mm in thickness, or both during a pretreatment interval of 6 months or more and a matched control group of 30 promptly treated patients. Matching criteria included patient age (±10 years), largest basal tumor diameter (±2 mm), tumor thickness (±1.5 mm), location of anterior tumor margin (same defined zone), and visual symptoms (present or absent).

Setting:  The Oncology Unit of the Retina Service at Wills Eye Hospital, Philadelphia, Pa.

Interventions:  All patients were treated in a nonrandomized fashion by conventional therapeutic methods appropriate to the tumor's size, location, and other factors.

Main Outcome Measures:  Actuarial melanoma-specific mortality and all-cause mortality.

Results:  The mean±SE cumulative 5-year probability of melanoma-specific mortality relative to the date of initial examination was 17.1%±7% in the delayed treatment group and 18.4%±8% in the prompt treatment group. This difference is not statistically significant (P>.5, log rank test).

Conclusions:  These results lend support to the belief that delayed treatment of selected small and dormant-appearing choroidal and ciliary body melanomas does not substantially increase the probability of melanoma-specific mortality; however, they do not prove that observation is the correct management option for all patients with a posterior uveal melanoma.