[Skip to Content]
[Skip to Content Landing]
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.

Gass JDM.  Observation of suspected choroidal and ciliary body melanomas for evidence of growth prior to enucleation . Ophthalmology . 1980;87:523-528.Article
Packard RBS.  In malignant choroidal melanoma will a delay in radical treatment influence prognosis? Trans Ophthalmol Soc U K . 1983;103:49-53.
Zimmerman LE, McLean IW.  Do growth and onset of symptoms of uveal melanomas indicate subclinical metastasis? Ophthalmology . 1984;91:685-691.Article
Augsburger JJ, Gamel JW, Sardi VF, Greenberg RA, Shields JA, Brady LW.  Enucleation vs cobalt plaque radiotherapy for malignant melanomas of the choroid and ciliary body . Arch Ophthalmol . 1986;104:655-661.Article
Augsburger JJ, Gamel JW, Lauritzen K, Brady LW.  Cobalt-60 plaque radiotherapy vs enucleation for posterior uveal melanoma . Am J Ophthalmol . 1990;109:585-592.
Augsburger JJ, Gamel JW, Bailey RS, Donoso LA, Gonder JR, Shields JA.  Accuracy of clinical estimates of tumor dimensions: a clinical-pathologic correlation study of posterior uveal melanomas . Retina . 1985;5:26-29.Article
Lee ET. Statistical Methods for Survival Data Analysis . Belmont, Calif: Lifetime Learning Publications; 1980:76-78, 129-131.
Feinstein AR.  The other side of 'statistical significance': alpha, beta, delta, and the calculation of sample size . Clin Pharmacol Ther . 1975;18:491-505.
Lilienfeld AM, Lilienfeld DE. Foundations of Epidemiology . 2nd ed. New York, NY: Oxford University Press Inc; 1980:351-352.
Gullen WH.  A danger in matched-control studies . JAMA . 1980;244:2279-2280.Article
Augsburger JJ, Schroeder RP, Territo C, Gamel JW, Shields JA.  Clinical parameters predictive of enlargement of melanocytic choroidal lesions . Br J Ophthalmol . 1989;73:911-917.Article
Manschot WA, van Strik R.  Uveal melanoma: therapeutic consequences of doubling times and irradiation results: a review . Int Ophthalmol . 1992;16:91-99.Article
Angell M.  Patients' preferences in randomized clinical trials . N Engl J Med . 1984;310:1385-1387.Article
Augsburger JJ. Is observation really appropriate management for choroidal melanomas? Trans Am Ophthalmol Soc. In press.
Frieman JA, Chalmers TC, Smith H, Kuebler RR.  The importance of beta, the type II error and sample size in the design and interpretation of the randomized clinical trial: survey of 71 'negative' trials . N Engl J Med . 1978;299:690-694.Article