A box-and-whisker plot shows medians and ranges of Scottish Index of Multiple Deprivation (SIMD) scores for choroidal melanoma treatment groups. A SIMD score of 1 indicates most deprived; a score of 6505, least deprived.
Lockington D, Chadha V, Russell H, Young D, Cauchi P, Kemp E. Socioeconomic Status and Choroidal Melanoma in Scotland. Arch Ophthalmol. 2010;128(3):383-384. doi:10.1001/archophthalmol.2009.407
The adverse effect of socioeconomic deprivation on health and mortality is well recognized in the United Kingdom, particularly for health inequalities in Scotland.1,2 We evaluated the demographic characteristics and audited the management of our patients with choroidal melanoma at the only ocular oncology tertiary referral center in Scotland.
A retrospective record review was performed for clinical details at the first visit and subsequent treatments since January 1, 1994, for all patients with choroidal melanoma examined at the National Ocular Oncology Service at Tennent Institute of Ophthalmology, Glasgow, Scotland. All cases of choroidal melanoma in Scotland are referred from local ophthalmologists, general practitioners, and primary eye services to this center for initial evaluation. Choroidal melanoma was diagnosed via clinical appearance and ultrasonographic findings. Home address postcode was used to determine the Scottish Index of Multiple Deprivation score and correlated with the distribution of incidence and treatment modality. The Scottish Index of Multiple Deprivation records 7 domains (current income, employment, health, education skills and training, geographic access to services, housing, and crime). The data zones are ranked from most deprived (score of 1) to least deprived (score of 6505), leading to a picture of relative area deprivation across Scotland (http://www.scotland.gov.uk/Topics/Statistics/SIMD).
A total of 536 patients were identified from January 1, 1994, to December 31, 2008, equating to 35.7 cases/year with an annual incidence of 7 per 1 million population. Mean (SD) age at the initial visit was 63.8 (13.7) years; 54.1% of the patients were male; and 50.4% of the lesions occurred in the right eye. All patients had unilateral pathological findings. The average wait from referral to the first review at the ophthalmic oncology clinic was 17 days. Among the patients, 42.1% had an initial visual acuity of 6/9 or better and 28.8% had an initial visual acuity of 6/60 or worse. The lesion diameter was less than 10 mm (small) for 50.4% of patients, 10 to 15 mm (medium) for 38.3%, and greater than 15 mm (large) for 11.3%. There were 630 interventions, including ruthenium plaque radiotherapy for 51.1%, proton beam radiotherapy for 26.4%, and enucleation for 18.3% (8.2% primary enucleation). Other interventions included cataract surgery, vitrectomy, and local resection. No treatment group was normally distributed (P < .005). There was no significant difference in the median Scottish Index of Multiple Deprivation scores between the main treatment groups (Kruskal-Wallis P = .91) (Figure).
The demographic characteristics of our patients are comparable to those of patients in other documented studies of uveal melanoma.3- 5 The literature does not appear to describe clear risk factors for this uncommon malignant neoplasm. In keeping with this, socioeconomic status was not found to be a significant factor for choroidal melanoma or subsequent treatment modality in this study. This was remarkable as social deprivation has been strongly associated with poor attendance at retinal screening events for diabetic eye disease and with subsequent poor outcomes.6 We initially expected patients from a higher area of deprivation to make their initial visit later and therefore have a higher rate of enucleation. This was not found to be the case. The patients' address (postcode) did not appear to influence management of their condition. The distribution of choroidal melanoma in Scotland was not seen to be more prevalent in any particular socioeconomic group. This is particularly relevant as the Scottish Executive has recently released funding to enable optometric practices to provide subsidized initial consultations. This is intended to improve and streamline referrals to hospital eye services. Further awareness of these subsidized services in all socioeconomic groups could result in earlier detection and influence subsequent management of uveal melanoma. This could play a future role in maintaining a low enucleation rate.
Correspondence: Dr Lockington, Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Rd, Glasgow G12 0YN, Scotland (firstname.lastname@example.org).
Financial Disclosure: None reported.