IMPACT OF DELAYED TREATMENT IN GROWING POSTERIOR UVEAL MELANOMAS

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