INFERRED NATURAL-HISTORY OF UVEAL MELANOMA

  • 1 January 1980
    • journal article
    • research article
    • Vol. 19  (7) , 760-770
Abstract
The fatality rate of patients with posterior uveal melanomas rapidly increased from a very low rate prior to enucleation to a maximum of 8%/yr during the 2nd yr after enucleation. Events related to enucleation probably have a deleterious effect on survival; these events are either the iatrogenic dissemination of tumor cells or an adverse effect on the immune defense system, or both. Others have proposed that the relationship between enucleation and increased mortality is only happenstance; they would attribute the onset of symptoms to the rapid growth of the malignant tumor and claim that this brings the patient to enucleation soon after the tumor becomes malignant. Cases (2105) on file in the Registry of Ophthalmic Pathology [Armed Forces Institute of Pathology, Washington Hospital Center, Washington, D.C., USA] were studied. Enucleation was not always performed shortly after the onset of visual disturbance. In 1/3 of the cases, enucleation was delayed until onset of pain from glaucoma or inflammation. In 1/3 of the cases medical treatment was not obtained until the tumor measured larger than 15 mm in diameter. Using Zelen''s method to infer the natural history of uveal melanoma, the mean time it took for a small tumor (less than 10 mm in diameter) to become a large tumor (greater than 15 mm) was approximately 7 yr. The average age of patients treated for medium-sized tumors was 5 yr less than that of patients treated for larger tumors. This is interpreted as evidence of an average delay of 5 yr in the treatment of large melanomas. If this delay is taken into consideration, then the patients treated with medium-sized tumors had a worse survival during the 1st 7 yr than did patients whose treatment was delayed until the tumor became large. After the 7th yr the survival was better. The postoperative increase in mortality during the 1st several years, particularly among patients with tumors of medium size, apparently was related to enucleation.

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