Is observation really appropriate for small choroidal melanomas.

Many, if not most, patients with a suspected small choroidal melanoma are currently managed by observation until tumor enlargement is documented. Current evidence appears to be insufficient to determine the correctness of this approach. A randomized clinical trial that could resolve this issue is probably not feasible. In the absence of satisfactory evidence, the decision about how to manage such patients depends on a subjective benefit-risk analysis that takes into account two competing but indeterminate risks: the risk of inadequate treatment for those patients who have a true melanoma and the risk of excessive treatment for those who have a benign nevus. Technologic advances and development of effective treatment for metastatic disease may eliminate most of the concern that currently accompanies observation as management for such tumors in the future.