Abstract
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.
Full text
PDF




























Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Ahmann D. L., Creagan E. T., Hahn R. G., Edmonson J. H., Bisel H. F., Schaid D. J. Complete responses and long-term survivals after systemic chemotherapy for patients with advanced malignant melanoma. Cancer. 1989 Jan 15;63(2):224–227. doi: 10.1002/1097-0142(19890115)63:2<224::aid-cncr2820630203>3.0.co;2-i. [DOI] [PubMed] [Google Scholar]
- Augsburger J. J., Gamel J. W. Clinical prognostic factors in patients with posterior uveal malignant melanoma. Cancer. 1990 Oct 1;66(7):1596–1600. doi: 10.1002/1097-0142(19901001)66:7<1596::aid-cncr2820660726>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
- Augsburger J. J., Gonder J. R., Amsel J., Shields J. A., Donoso L. A. Growth rates and doubling times of posterior uveal melanomas. Ophthalmology. 1984 Dec;91(12):1709–1715. doi: 10.1016/s0161-6420(84)34088-x. [DOI] [PubMed] [Google Scholar]
- Augsburger J. J. Ocular tumors: does treatment work? Ophthalmic Surg. 1990 Jan;21(1):9–14. [PubMed] [Google Scholar]
- Augsburger J. J., Schroeder R. P., Territo C., Gamel J. W., Shields J. A. Clinical parameters predictive of enlargement of melanocytic choroidal lesions. Br J Ophthalmol. 1989 Nov;73(11):911–917. doi: 10.1136/bjo.73.11.911. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Augsburger J. J., Shields J. A., Folberg R., Lang W., O'Hara B. J., Claricci J. D. Fine needle aspiration biopsy in the diagnosis of intraocular cancer. Cytologic-histologic correlations. Ophthalmology. 1985 Jan;92(1):39–49. doi: 10.1016/s0161-6420(85)34068-x. [DOI] [PubMed] [Google Scholar]
- Blodi F. C., Roy P. E. The misdiagnosed choroidal melanoma. Can J Ophthalmol. 1967 Jul;2(3):209–211. [PubMed] [Google Scholar]
- Chang M., Zimmerman L. E., McLean I. The persisting pseudomelanoma problem. Arch Ophthalmol. 1984 May;102(5):726–727. doi: 10.1001/archopht.1984.01040030582024. [DOI] [PubMed] [Google Scholar]
- Char D. H., Heilbron D. C., Juster R. P., Stone R. D. Choroidal melanoma growth patterns. Br J Ophthalmol. 1983 Sep;67(9):575–578. doi: 10.1136/bjo.67.9.575. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Char D. H., Hogan M. J. Management of small elevated pigmented choroidal lesions. Br J Ophthalmol. 1977 Jan;61(1):54–58. doi: 10.1136/bjo.61.1.54. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Chong C. A., Gregor R. J., Augsburger J. J., Montana J. Spontaneous regression of choroidal melanoma over 8 years. Retina. 1989;9(2):136–138. doi: 10.1097/00006982-198909020-00013. [DOI] [PubMed] [Google Scholar]
- Coleman D. J., Silverman R. H., Rondeau M. J., Lizzi F. L., McLean I. W., Jakobiec F. A. Correlations of acoustic tissue typing of malignant melanoma and histopathologic features as a predictor of death. Am J Ophthalmol. 1990 Oct 15;110(4):380–388. doi: 10.1016/s0002-9394(14)77018-7. [DOI] [PubMed] [Google Scholar]
- DAVIES W. S. Malignant melanomas of the choroid and ciliary body. A clinicopathologic study. Am J Ophthalmol. 1963 Mar;55:541–546. [PubMed] [Google Scholar]
- DUNPHY E. B., FORREST A. W., LEOPOLD I. H., REESE A. B., ZIMMERMAN L. E. The diagnosis and management of intraocular melanomas: a symposium. Trans Am Acad Ophthalmol Otolaryngol. 1958 Jul-Aug;62(4):517–555. [PubMed] [Google Scholar]
- Davidorf F. H., Letson A. D., Weiss E. T., Levine E. Incidence of misdiagnosed and unsuspected choroidal melanomas. A 50-year experience. Arch Ophthalmol. 1983 Mar;101(3):410–412. doi: 10.1001/archopht.1983.01040010410013. [DOI] [PubMed] [Google Scholar]
- De Potter P., von Weymarn C., Zografos L. In vivo phosphorus 31 magnetic resonance spectroscopy of human uveal melanomas and other intraocular tumors. Am J Ophthalmol. 1991 Mar 15;111(3):276–288. doi: 10.1016/s0002-9394(14)72310-4. [DOI] [PubMed] [Google Scholar]
- FERRY A. P. LESIONS MISTAKEN FOR MALIGNANT MELANOMA OF THE POSTERIOR UVEA. A CLINICOPATHOLOGIC ANALYSIS OF 100 CASES WITH OPHTHALMOSCOPICALLY VISIBLE LESIONS. Arch Ophthalmol. 1964 Oct;72:463–469. doi: 10.1001/archopht.1964.00970020463004. [DOI] [PubMed] [Google Scholar]
- Fletcher R. H. The costs of clinical trials. JAMA. 1989 Oct 6;262(13):1842–1842. [PubMed] [Google Scholar]
- Gass J. D. Observation of suspected choroidal and ciliary body melanomas for evidence of growth prior to enucleation. Ophthalmology. 1980 Jun;87(6):523–528. doi: 10.1016/s0161-6420(80)35200-7. [DOI] [PubMed] [Google Scholar]
- Gass J. D. Problems in the differential diagnosis of choroidal nevi and malignant melanomas. The XXXIII Edward Jackson Memorial Lecture. Am J Ophthalmol. 1977 Mar;83(3):299–323. doi: 10.1089/ten.2005.11.1254. [DOI] [PubMed] [Google Scholar]
- Gomori J. M., Grossman R. I., Shields J. A., Augsburger J. J., Joseph P. M., DeSimeone D. Choroidal melanomas: correlation of NMR spectroscopy and MR imaging. Radiology. 1986 Feb;158(2):443–445. doi: 10.1148/radiology.158.2.3941871. [DOI] [PubMed] [Google Scholar]
- Gragoudas E. S., Egan K. M., Seddon J. M., Glynn R. J., Walsh S. M., Finn S. M., Munzenrider J. E., Spar M. D. Survival of patients with metastases from uveal melanoma. Ophthalmology. 1991 Mar;98(3):383–390. doi: 10.1016/s0161-6420(91)32285-1. [DOI] [PubMed] [Google Scholar]
- Gragoudas E. S., Seddon J. M., Egan K. M., Polivogianis L., Hsieh C. C., Goitein M., Verhey L., Munzenrider J., Austin-Seymour M., Urie M. Prognostic factors for metastasis following proton beam irradiation of uveal melanomas. Ophthalmology. 1986 May;93(5):675–680. doi: 10.1016/s0161-6420(86)33699-6. [DOI] [PubMed] [Google Scholar]
- Gundersen T., Smith T. R., Zakov N., Albert D. M. Choroidal melanocytic tumor observed for 41 years before enucleation. Arch Ophthalmol. 1978 Nov;96(11):2089–2092. doi: 10.1001/archopht.1978.03910060469017. [DOI] [PubMed] [Google Scholar]
- Guthoff R. F., Berger R. W., Winkler P., Helmke K., Chumbley L. C. Doppler ultrasonography of malignant melanomas of the uvea. Arch Ophthalmol. 1991 Apr;109(4):537–541. doi: 10.1001/archopht.1991.01080040105038. [DOI] [PubMed] [Google Scholar]
- Harry J. Symposium on management of melanoma of the uveal tract. Errors in diagnosis. Trans Ophthalmol Soc U K. 1973;93(0):93–102. [PubMed] [Google Scholar]
- Hermann P., Blanchard D., de Saint-Vis B., Fossiez F., Gaillard C., Vanbervliet B., Brière F., Banchereau J., Galizzi J. P. Expression of a 32-kDa ligand for the CD40 antigen on activated human T lymphocytes. Eur J Immunol. 1993 Apr;23(4):961–964. doi: 10.1002/eji.1830230430. [DOI] [PubMed] [Google Scholar]
- Howard G. M. Erroneous clinical diagnoses of retinoblastoma and uveal melanoma. Trans Am Acad Ophthalmol Otolaryngol. 1969 Mar-Apr;73(2):199–203. [PubMed] [Google Scholar]
- Howell W. B. Ode to the Appendix. Can Med Assoc J. 1937 Feb;36(2):196–196. [PMC free article] [PubMed] [Google Scholar]
- KIRK H. Q., PETTY R. W. Malignant melanoma of the choroid; a correlation of clinical and histological findings. AMA Arch Ophthalmol. 1956 Dec;56(6):843–860. doi: 10.1001/archopht.1956.00930040855007. [DOI] [PubMed] [Google Scholar]
- Lambert S. R., Char D. H., Howes E., Jr, Crawford J. B., Wells J. Spontaneous regression of a choroidal melanoma. Arch Ophthalmol. 1986 May;104(5):732–734. doi: 10.1001/archopht.1986.01050170122036. [DOI] [PubMed] [Google Scholar]
- Lavin P. T., Albert D. M., Seddon J. M. A deficit survival analysis to assess the natural history of uveal melanoma. J Chronic Dis. 1984;37(6):481–487. doi: 10.1016/0021-9681(84)90031-6. [DOI] [PubMed] [Google Scholar]
- MacIlwaine W. A., 4th, Anderson B., Jr, Klintworth G. K. Enlargement of a histologically documented choroidal nevus. Am J Ophthalmol. 1979 Apr;87(4):480–486. doi: 10.1016/0002-9394(79)90234-4. [DOI] [PubMed] [Google Scholar]
- Manschot W. A., Van Strik R. Is irradiation a justifiable treatment of choroidal melanoma? Analysis of published results. Br J Ophthalmol. 1987 May;71(5):348–352. doi: 10.1136/bjo.71.5.348. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Manschot W. A., van Peperzeel H. A. Choroidal melanoma. Enucleation or observation? A new approach. Arch Ophthalmol. 1980 Jan;98(1):71–77. doi: 10.1001/archopht.1980.01020030073002. [DOI] [PubMed] [Google Scholar]
- Maumenee A. E. An evaluation of enucleation in the management of uveal melanomas. Am J Ophthalmol. 1979 Jun;87(6):846–847. doi: 10.1016/0002-9394(79)90369-6. [DOI] [PubMed] [Google Scholar]
- McKnight S. J., Christensen G. R. Metastasis of a very small choroidal melanoma without apparent clinical change. Ann Ophthalmol. 1984 Nov;16(11):1016–1021. [PubMed] [Google Scholar]
- McLean I. W., Foster W. D., Zimmerman L. E. Uveal melanoma: location, size, cell type, and enucleation as risk factors in metastasis. Hum Pathol. 1982 Feb;13(2):123–132. doi: 10.1016/s0046-8177(82)80116-0. [DOI] [PubMed] [Google Scholar]
- McLean I. W., Zimmerman L. E., Evans R. M. Reappraisal of Callender's spindle a type of malignant melanoma of choroid and ciliary body. Am J Ophthalmol. 1978 Oct;86(4):557–564. doi: 10.1016/0002-9394(78)90307-0. [DOI] [PubMed] [Google Scholar]
- McLean M. J., Foster W. D., Zimmerman L. E. Prognostic factors in small malignant melanomas of choroid and ciliary body. Arch Ophthalmol. 1977 Jan;95(1):48–58. doi: 10.1001/archopht.1977.04450010050004. [DOI] [PubMed] [Google Scholar]
- Mims J. L., 3rd, Shields J. A. Follow-up studies of suspicious choroidal nevi. Ophthalmology. 1978 Sep;85(9):929–943. doi: 10.1016/s0161-6420(78)35597-4. [DOI] [PubMed] [Google Scholar]
- Pach J. M., Robertson D. M. Metastasis from untreated uveal melanomas. Arch Ophthalmol. 1986 Nov;104(11):1624–1625. doi: 10.1001/archopht.1986.01050230062032. [DOI] [PubMed] [Google Scholar]
- Packard R. B. In malignant choroidal melanoma will a delay in radical treatment influence prognosis? Trans Ophthalmol Soc U K. 1983;103(Pt 1):49–53. [PubMed] [Google Scholar]
- Pyrhönen S., Hahka-Kemppinen M., Muhonen T. A promising interferon plus four-drug chemotherapy regimen for metastatic melanoma. J Clin Oncol. 1992 Dec;10(12):1919–1926. doi: 10.1200/JCO.1992.10.12.1919. [DOI] [PubMed] [Google Scholar]
- Rankin S. J., Johnston P. B. Metastatic disease from untreated choroidal and ciliary body melanomas. Int Ophthalmol. 1991 Mar;15(2):75–78. doi: 10.1007/BF01046425. [DOI] [PubMed] [Google Scholar]
- Robertson D. M., Campbell R. J. Errors in the diagnosis of malignant melanoma of the choroid. Am J Ophthalmol. 1979 Mar;87(3):269–275. doi: 10.1016/0002-9394(79)90060-6. [DOI] [PubMed] [Google Scholar]
- Sahel J. A., Pesavento R., Frederick A. R., Jr, Albert D. M. Melanoma arising de novo over a 16-month period. Arch Ophthalmol. 1988 Mar;106(3):381–385. doi: 10.1001/archopht.1988.01060130407031. [DOI] [PubMed] [Google Scholar]
- Saraux H., Pelosse B. Histoire naturelle des mélanomes malins de la choroïde. J Fr Ophtalmol. 1988;11(2):169–175. [PubMed] [Google Scholar]
- Seddon J. M., Albert D. M., Lavin P. T., Robinson N. A prognostic factor study of disease-free interval and survival following enucleation for uveal melanoma. Arch Ophthalmol. 1983 Dec;101(12):1894–1899. doi: 10.1001/archopht.1983.01040020896012. [DOI] [PubMed] [Google Scholar]
- Shammas H. F., Blodi F. C. Prognostic factors in choroidal and ciliary body melanomas. Arch Ophthalmol. 1977 Jan;95(1):63–69. doi: 10.1001/archopht.1977.04450010065005. [DOI] [PubMed] [Google Scholar]
- Shields J. A. Lesions simulating malignant melanoma of the posterior uvea. Arch Ophthalmol. 1973 Jun;89(6):466–471. doi: 10.1001/archopht.1973.01000040468004. [DOI] [PubMed] [Google Scholar]
- Straatsma B. R., Fine S. L., Earle J. D., Hawkins B. S., Diener-West M., McLaughlin J. A. Enucleation versus plaque irradiation for choroidal melanoma. Ophthalmology. 1988 Jul;95(7):1000–1004. doi: 10.1016/s0161-6420(88)33086-1. [DOI] [PubMed] [Google Scholar]
- Thomas J. V., Green W. R., Maumenee A. E. Small choroidal melanomas. A long-term follow-up study. Arch Ophthalmol. 1979 May;97(5):861–864. doi: 10.1001/archopht.1979.01020010419001. [DOI] [PubMed] [Google Scholar]
- Völcker H. E., Naumann G. O. Klinisch unerwartete maligne Melanome der hinteren Uvea. Klin Monbl Augenheilkd. 1976 Mar;168(3):311–317. [PubMed] [Google Scholar]
- Wilhelm J. L., Zakov Z. N. Choroidal malignant melanoma with liver metastasis before enucleation. Ann Ophthalmol. 1982 Aug;14(8):789-91, 794-6. [PubMed] [Google Scholar]
- Wolff-Kormann P. G., Kormann B. A., Riedel K. G., Hasenfratz G. C., Stefani F. H., Spengel F. A., Lund O. E. Quantitative color Doppler imaging in untreated and irradiated choroidal melanoma. Invest Ophthalmol Vis Sci. 1992 May;33(6):1928–1933. [PubMed] [Google Scholar]
- Zimmerman L. E., McLean I. W. Do growth and onset of symptoms of uveal melanomas indicate subclinical metastasis? Ophthalmology. 1984 Jun;91(6):685–691. doi: 10.1016/s0161-6420(84)34243-9. [DOI] [PubMed] [Google Scholar]
- Zimmerman L. E., McLean I. W., Foster W. D. Does enucleation of the eye containing a malignant melanoma prevent or accelerate the dissemination of tumour cells. Br J Ophthalmol. 1978 Jun;62(6):420–425. doi: 10.1136/bjo.62.6.420. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Zimmerman L. E., McLean I. W. Metastatic disease from untreated uveal melanomas. Am J Ophthalmol. 1979 Sep;88(3 Pt 1):524–534. doi: 10.1016/0002-9394(79)90658-5. [DOI] [PubMed] [Google Scholar]
- Zimmerman L. E., McLean I. W. The natural course of untreated uveal melanomas. Doc Ophthalmol. 1980 Dec 15;50(1):75–82. doi: 10.1007/BF00161153. [DOI] [PubMed] [Google Scholar]
- Zimmerman L. E. Problems in the diagnosis of malignant melanomas of the choroid and ciliary body. The 1972 Arthur J. Bedell Lecture. Am J Ophthalmol. 1973 Jun;75(6):917–929. doi: 10.1016/0002-9394(73)91079-9. [DOI] [PubMed] [Google Scholar]
