MALIGNANT MELANOMAS OF THE HUMAN UVEA

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Abstract
All cases (302) of malignant intraocular melanomas in Denmark between 1943-1952 were followed up and evaluated 25 yr. after enucleation, which was the treatment used immediately after diagnosis during that period. Follow-up was 99%, 82% of the total died during follow-up. The same series was analyzed in 1963 and 1970. Of the patients, 3/4 were hospitalized immediately before and/or in the process of dying. In the series of choroidal and/or ciliary body melanoma the autopsy frequency was 36. Death with metastases took place in 51% (150). Orbital recurrence was found in 2.5% and in 8-12% of cases with extrascleral extension. This appeared at an average of 2 yr after enucleation and 10% of metastases appeared within the first 6 mo. post-operatively, more than half within 3 yr. Peak incidence was during the 1st yr after enucleation. No 2nd peak was observed. Metastases appeared even after 23 yr. The probability of being alive without metastases after 25 yr was 40%, assuming that the patient did not die of another cause. The prognosis was estimated using various clinical and histopathological parameters. Women < 40 yr had a better prognosis than women above that age. Small tumors, spindle-shaped cells, no invasion and low pigment content of tumor were all in favor of a good prognosis. Of the iris melanomas from the period dealt with, only 1 died with metastasis. A discussion on early enucleation or conservative managemnt is presented and the attitude of the Ophthalmic Tumor Center [Denmark] towards therapy is indicated.

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