Small, fatal choroidal melanoma: a retrospective study of patients treated in Liverpool

Purpose To review the Liverpool experience of small, fatal uveal melanomas. Methods We searched the database of the Liverpool Ocular Oncology Service for British patients dying from metastatic disease after treatment of a uveal melanoma having a basal diameter less than 10.0mm (i.e., ‘small melanoma’). The cause of death was obtained from death certificates provided by the National Health Service Cancer Registry. Results Of the 3186 patients first treated for uveal melanoma in Liverpool between January 1993 and July 2008, there were 994 (31%) with a small melanoma. In 803 of these patients residing in mainland Britain, the 15-year actuarial survival was 88.4%. The 35 patients dying of melanoma (19 female, 16 male) had a median age of 72 years at primary treatment (range 43-88). The tumours had a median diameter of 7.6mm (range 3.2-9.9) with nine measuring less than 7.0mm. The posterior tumour margin was located in iris in 1 patient, ciliary body in 6 patients and choroid in 29 patients. The initial management consisted of brachytherapy (14 patients), proton beam radiotherapy (9), enucleation (5), local resection (2), transpupillary thermotherapy (3) and observation (2). Histological studies had been performed in 11 tumours, 9 of which contained epithelioid cells. Cytogenetic data were available for four tumours, two of which showed monosomy 3. Three patients had developed local tumour recurrence after their initial treatment. The median time to death was 4.8 years (range 0.1 – 13.7). This survival time was longer than in fatal cases with a medium-sized or large tumour (Log rank, p<0.001). Conclusion Multicentre studies are indicated to understand the metastatic process and how this is influenced by ocular treatment.