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LARGE UVEAL MELANOMA (≥10 MM THICKNESS): Clinical Features and Millimeter-by-Millimeter Risk of Metastasis in 1311 Cases. The 2018 Albert E. Finley Lecture

Shields, Carol L., MD; Sioufi, Kareem, MD; Robbins, Justin S., BS; Barna, Laura E., BS, MS; Harley, Maxwell R., BA; Lally, Sara E., MD; Say, Emil Anthony T., MD; Mashayekhi, Arman, MD; Shields, Jerry A., MD

doi: 10.1097/IAE.0000000000002144
Original Study: PDF Only

Purpose: To analyze the clinical features and rate of metastatic disease in eyes with large (≥10 mm thickness) uveal melanoma.

Design: Retrospective noncomparative case series.

Participants: There were 1,311 consecutive patients.

Methods: Retrospective medical chart review.

Main outcome measures: Clinical features and rate of metastatic melanoma.

Results: Of 1,311 patients with large melanoma, the mean age was 59 years (median 60, range 6–98 years) and 95% were white. Mean tumor basal dimension was 17 mm (median 17, range 7–25 mm), and mean tumor thickness was 12 mm (median 12, range 10–24 mm). Mean distance to the foveola was 6 mm (median 6, range 0–19 mm) and to optic nerve was 6 mm (median 5, range 0–19 mm). Of all eyes, using Kaplan–Meier analysis, metastasis occurred in 11, 30, 45, and 52% at 1, 3, 5, and 7 years, respectively. According to tumor thickness (10.0–11.0, 11.1–12.0, 12.1–13.0, 13.1–14.0, 14.1–15.0, 15.1–16.0, and >16.0 mm), metastasis at 1 year was found in 7, 12, 13, 15, 18, 22, and 20%; metastasis at 3 years was 24, 27, 37, 35, 51, 69, and 57%; metastasis at 5 years was 38%, 42%, 56%, 48%, 61%, not available, and 66%; and metastasis at 7 years was 47%, 47%, 61%, 57%, 61%, not available, and 66%. Clinical features associated with fewer metastatic events included Bruch membrane rupture (7-year metastasis at 48%, P = 0.018) and macular location (7-year metastasis at 32%, P = 0.014), whereas those with worse outcome included extraocular extension (7-year metastasis at 79%, P < 0.001). There was no significant difference in rate of melanoma-related metastasis for patients treated with plaque radiotherapy versus enucleation.

Conclusion: Large uveal melanoma demonstrates 7-year rate of metastasis at 52%, with generalized increasing risk per 1-mm or 2-mm thickness increments. Extraocular extension was associated with greater metastatic rate, whereas Bruch membrane rupture and macular location demonstrated lower rate.

Large uveal melanoma (≥10 mm thickness) demonstrated 7-year rate of metastasis at 52%, with increasing risk per 1-mm or 2-mm thickness increments. Extraocular extension was associated with greater metastatic rate, whereas Bruch membrane rupture and macular location demonstrated lower rate. Metastatic rate was similar for plaque radiotherapy versus enucleation.

Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.

Reprint requests: Carol L. Shields, MD, Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, Suite 1440, Philadelphia, PA 19107; e-mail: carolshields@gmail.com

Supported by Eye Tumor Research Foundation, Philadelphia, PA (C.L.S. and J.A.S.).

Presented in part as the Albert E. Finley Lecture at the University of North Carolina, Chapel Hill, NC, February 3, 2018 (C.L.S.).

None of the authors has any financial/conflicting interests to disclose.

The funders had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; and in the preparation, review, or approval of the manuscript. C. L. Shields has had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Biostatistical evaluation provided by Rishita Nutheti, PhD.

© 2018 by Ophthalmic Communications Society, Inc.