Uveal melanoma natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

If left untreated, 50% of patients with uveal melanoma may progress to develop metastasis. Common complications of uveal melanoma include glaucoma, vision loss, and metastasis. Prognosis is generally good for patients with iris melanoma, and the 10 year-survival for iris melanoma is approximately 95 percent and for ciliochoroidal tumors is 77 percent respectively.

Natural History, Complications, and Prognosis

Natural history

Complications

Complications of eye melanoma include the following:[3]

Complications of therapy of uveal melanoma

Prognosis

  • The 5-year mortality rate associated with metastasis from ciliary body or choroidal melanoma is approximately 30%, compared with a rate of 2% to 3% for iris melanomas.[5][6]
  • Overall survival depends on tumor size, extraocular spread, and metastases. Even small (<10 mm diameter, <3 mm thickness) tumors still carry a 10-15% 5-year mortality.
  • The 10 year-survival for iris melanoma is approximately 95 percent and for ciliochoroidal tumors is 77 percent respectively.
  • The tumor node metastasis (TNM) staging system of the American Joint Committee on Cancer takes into account the key factors involved which are known to be of prognostic significance.
  • The prognosis is usually poor when local control is not achieved with the initial treatment.[7][8]
  • Detection of circulating tumor cells at the time of diagnosis is an independent risk factor for relapse and shortened survival in patients at high-risk based upon clinical parameters.[9][10]
  • The prognosis for any patient with recurring or relapsing disease is poor, regardless of cell type or stage.

References

  1. Wöll E, Bedikian A, Legha SS (1999). "Uveal melanoma: natural history and treatment options for metastatic disease". Melanoma Res. 9 (6): 575–81. PMID 10661768.
  2. Jovanovic P, Mihajlovic M, Djordjevic-Jocic J, Vlajkovic S, Cekic S, Stefanovic V (2013). "Ocular melanoma: an overview of the current status". Int J Clin Exp Pathol. 6 (7): 1230–44. PMC 3693189. PMID 23826405.
  3. Singh, Arun D., and Bertil Damato. Clinical ophthalmic oncology : uveal tumors. Heidelberg: Springer, 2014. Print.
  4. Summanen, P; Immonen, I; Kivela, T; Tommila, P; Heikkonen, J; Tarkkanen, A (1996). "Radiation related complications after ruthenium plaque radiotherapy of uveal melanoma". British Journal of Ophthalmology. 80 (8): 732–739. doi:10.1136/bjo.80.8.732. ISSN 0007-1161.
  5. Shields, CarolL; Mellen, PhoebeL; Morton, SpenserJ (2013). "American joint committee on cancer staging of uveal melanoma". Oman Journal of Ophthalmology. 6 (2): 116. doi:10.4103/0974-620X.116652. ISSN 0974-620X.
  6. Shields CL, Kaliki S, Furuta M, Fulco E, Alarcon C, Shields JA (2013). "American Joint Committee on Cancer classification of posterior uveal melanoma (tumor size category) predicts prognosis in 7731 patients". Ophthalmology. 120 (10): 2066–71. doi:10.1016/j.ophtha.2013.03.012. PMID 23664467.
  7. Egger E, Zografos L, Schalenbourg A, Beati D, Böhringer T, Chamot L; et al. (2003). "Eye retention after proton beam radiotherapy for uveal melanoma". Int J Radiat Oncol Biol Phys. 55 (4): 867–80. PMID 12605964.
  8. Egan KM, Ryan LM, Gragoudas ES (1998). "Survival implications of enucleation after definitive radiotherapy for choroidal melanoma: an example of regression on time-dependent covariates". Arch Ophthalmol. 116 (3): 366–70. PMID 9514491.
  9. Schuster R, Bechrakis NE, Stroux A, Busse A, Schmittel A, Scheibenbogen C; et al. (2007). "Circulating tumor cells as prognostic factor for distant metastases and survival in patients with primary uveal melanoma". Clin Cancer Res. 13 (4): 1171–8. doi:10.1158/1078-0432.CCR-06-2329. PMID 17317826.
  10. Boldin I, Langmann G, Richtig E, Schwantzer G, Ardjomand N, Wegscheider B; et al. (2005). "Five-year results of prognostic value of tyrosinase in peripheral blood of uveal melanoma patients". Melanoma Res. 15 (6): 503–7. PMID 16314735.

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