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Retina:
doi: 10.1097/IAE.0b013e318285cd52
Original Study

DIFFUSE VERSUS NONDIFFUSE SMALL (≤3 MM THICKNESS) CHOROIDAL MELANOMA: Comparative Analysis in 1,751 Cases. The 2012 F. Phinizy Calhoun Lecture

Shields, Carol L. MD; Kaliki, Swathi MD; Furuta, Minoru MD; Shields, Jerry A. MD

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Abstract

Objective:

To determine prognosis of small choroidal melanoma (≤3 mm thickness) comparing diffuse versus nondiffuse variants.

Methods:

Retrospective chart review of 1,751 patients with small choroidal melanoma classified as diffuse (thickness/base ≤20%) versus nondiffuse (thickness/base >20%).

Results:

Of 1,751 patients with small choroidal melanoma, 297 (17%) were diffuse and 1,454 (83%) nondiffuse. Features with statistical differences (diffuse vs. nondiffuse) included mean distance to optic disk (3 vs. 4 mm), mean tumor base (12 vs. 8 mm), and mean tumor thickness (1.9 vs. 2.5 mm). Using Kaplan–Meier estimates, melanoma-related metastasis (diffuse vs. nondiffuse) was 8% versus 4% at 5 years, 16% versus 10% at 10 years, and 19% versus 16% at 15 years (P = 0.0344). Melanoma-related death was 6% versus 2% at 5 years, 11% versus 4% at 10 years, and 16% versus 6% at 15 years (P < 0.0001). In the subgroup of thin melanoma 2 mm or less in thickness, melanoma-related death was 7% versus 2% at 5 years, 10% versus 2% at 10 years, and 16% versus 4% at 15 years (P = 0.0077). By multivariate analysis, factors predictive of metastasis from diffuse melanoma included larger tumor basal dimension (P = 0.0027) and plateau/flat tumor configuration (P = 0.0257).

Conclusion:

Of 1751 patients with small (≤3 mm thickness) choroidal melanoma, those with diffuse tumor show higher probability of metastasis and death than those with nondiffuse tumor. This finding is evident even in the thinnest melanomas (≤2 mm thickness).

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