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.

DESIGN

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).

SETTING

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.