Combination of Clinical Factors Predictive of Growth of Small Choroidal Melanocytic Tumors | Oncology | JAMA Ophthalmology | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.239.177.24. Please contact the publisher to request reinstatement.
1.
Fitzpatrick  TBMihm  MCSober  AJRhodes  AR Clinical recognition of primary malignant melanoma and of its precursors. Fitzpatrick  TBEisen  AZWolff  KFreedberg  IMAusten  KFeds. Dermatology in General Medicine. 3rd ed. New York, NY McGraw-Hill1987;A38- A39Google Scholar
2.
Breslow  A Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma.  Ann Surg. 1970;172902- 908Google ScholarCrossref
3.
Balch  CMSoong  SJShaq  HM  et al.  An analysis of prognostic factors in 4000 patients with cutaneous melanoma. Balch  CMMilton  GWeds. Cutaneous Melanoma Clinical Management and Treatment Results Worldwide Philadelphia, Pa JB Lippincott1985;332Google Scholar
4.
Balch  CMSoong  SJShaw  HM  et al.  Changing trends in the clinical pathologic features of melanoma. Balch  CMHoughton  ANMilton  GWSober  ASoong  SJeds. Cutaneous Melanoma. 2nd ed. Philadelphia, Pa Lippincott1992;40Google Scholar
5.
American Academy of Dermatology, Melanoma/Skin Cancer: You Can Recognize the Signs.  Evanston, Ill American Academy of Dermatology1989;
6.
Diener-West  MHawkins  BSMarkowitz  JASchachat  AP A review of mortality from choroidal melanoma, II: a meta-analysis of 5-year mortality rates following enucleation, 1966 through 1988.  Arch Ophthalmol. 1992;110245- 250Google ScholarCrossref
7.
Shields  CLShields  JAKiratli  H  et al.  Risk factors for growth and metastasis of small choroidal melanocytic lesions.  Ophthalmology. 1995;1021351- 1361Google ScholarCrossref
8.
The Collaborative Ocular Melanoma Study Group, Mortality in patients with small choroidal melanoma: COMS Report No.4.  Arch Ophthalmol. 1997;115886- 893Google ScholarCrossref
9.
Augsburger  JJSchroeder  RPTerrito  CGamel  JWShields  JA Clinical parameters predictive of enlargment of melanocytic chorodal lesions.  Br J Ophthalmol. 1989;73911- 917Google ScholarCrossref
10.
Butler  PChar  DHZarbin  MKroll  S Natural history of indeterminate pigmented choroidal tumors.  Ophthalmology. 1994;101710- 706Google ScholarCrossref
11.
The Collaborative Ocular Melanoma Study Group, Factors predictive of growth and treatment of small choroidal melanoma: COMS Report No.5.  Arch Ophthalmol. 1997;1151537- 1544Google ScholarCrossref
12.
Lee  ET Statistical Methods for Survival Data Analysis. 2nd ed. New York, NY John Wiley & Sons Inc1992;258
13.
Balch  CMMurad  TMSoong  SJ  et al.  A multifactorial analysis of melanoma: prognostic histopathological features comparing Clark's and Breslow's staging methods.  Ann Surg. 1978;188732- 743Google ScholarCrossref
14.
Balch  CMMurad  TMSoong  SJ  et al.  Tumor thickness as a guide to surgical management of clinical stage I melanoma patients.  Cancer. 1979;43883- 888Google ScholarCrossref
15.
Day  CL  JrLew  RAMihm  MC  Jr  et al.  The natural break points for primary-tumor thickness in clinical stage 1 melanoma.  N Engl J Med. 1981;3051155Google Scholar
16.
Shields  JAShields  CL Management of Posterior Uveal Melanoma: Intraocular Tumors: A Text and Atlas.  Philadelphia, Pa WB Saunders Co1992;171- 205
Clinical Sciences
March 2000

Combination of Clinical Factors Predictive of Growth of Small Choroidal Melanocytic Tumors

Author Affiliations

From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pa.

Arch Ophthalmol. 2000;118(3):360-364. doi:10.1001/archopht.118.3.360
Abstract

Objective  To better define the effect of individual risk factors and combinations thereof on the growth of small choroidal melanocytic tumors.

Design  Retrospective analysis.

Setting  Clinical practice of ocular oncology.

Patients  The study included 1287 patients with small suspicious choroidal melanocytic tumors, measuring 3 mm or less in thickness, managed with observation.

Results  On multivariate analysis, the clinical risk factors predictive of growth of small choroidal melanocytic tumors include tumor thickness greater than 2.0 mm, posterior tumor margin touching the disc, visual symptoms, orange pigment, and subretinal fluid. Tumor growth was detected in 4% of those patients with no risk factors. Growth was detected in approximately 36% of patients with 1 risk factor, 45% of patients with 2 risk factors, 50% of patients with 3 risk factors, 51% of patients with 4 risk factors, and 56% of patients with all 5 risk factors. The combination of risk factors offering the greatest risk for growth was tumor thickness greater than 2.0 mm, tumor margin touching disc, and subretinal fluid that was associated with tumor growth in 63% of the affected patients. The relative risk for growth was 1.9 for 1 factor, 3.8 for 2 factors, 7.4 for 3 factors, 14.1 for 4 factors, and 27.1 for all 5 risk factors combined.

Conclusions  Five risk factors for growth of small choroidal melanocytic tumors have been identified. The combinations of various factors increase the risk for tumor growth from 4% if no factors are present to more than 50% if 3 or more risk factors are present. These factors may be important when counseling patients with small suspicious choroidal melanocytic tumors.

×