Abstract
Purpose To investigate the mode of presentation of uveal melanomas, delays in their diagnosis and the effect of delayed diagnosis on treatment outcome.
Methods An analysis was carried out of 50 consecutive patients undergoing treatment for uveal melanoma at the Ocular Oncology Service in Liverpool. The mode of presentation of the tumour, onset of symptoms and subsequent management were determined by interview at the time of treatment.
Results Seventy-two per cent of patients had one or more symptoms directly attributable to the tumour. These included blurred vision (36%), photopsia (22%), visual field loss (16%), floaters (4%) and metamorphopsia (4%). Forty-two per cent of patients experienced delays in the diagnosis and treatment due to misdiagnoses such as macular degeneration and naevus or due to the lesion being missed at the initial visit. Patients who had experienced delays in diagnosis received treatment after a mean of 6.6 months compared with 4.2 weeks for those who did not experience any delay (p = 0.003). Such patients were more likely to be treated by enucleation (52% vs 17%, p = 0.008) than by an eye-conserving method such as radiotherapy or trans-scleral local resection.
Conclusions The primary aim of treatment of uveal melanoma is to reduce the risk of death from metastases and a secondary aim is to conserve the eye with as much vision as possible. This study identifies common reasons for delays in the diagnosis of uveal melanoma. While the effect of early treatment on survival remains controversial, this study shows that patients who have their tumours diagnosed promptly are more likely to be treated by an eye-conserving method than by enucleation.
Similar content being viewed by others
Article PDF
References
Diener-West M, Hawkins BS, Markowitz JA, Schachat AP . A review of mortality from choroidal melanoma. II. A meta-analysis of 5-year mortality rates following enucleation, 1966 through 1988. Arch Ophthalmol 1992;110:245–50.
Lommatzch PK . Results after beta-irradiation (106Ru106Ru) of choroidal melanomas: 20 years' experience. Br J Ophthalmol 1986;70:844–51.
Gragoudas ES, Seddon JM, Egan K, et al. Long-term results of proton beam irradiated uveal melanomas. Ophthalmology 1987;94:349–53.
Damato BE, Foulds WS . Surgical resection of choroidal melanomas. In: Ryan SJ, editor. Retina, vol. 1, 2nd ed. St Louis: CV Mosby, 1994.
Lee KJ, Peyman GA, Raichand S . Internal eye wall resection for posterior uveal melanoma. Jpn J Ophthalmol 1993;37:287–92.
Manschot WA . The natural history of uveal melanomas and its therapeutic consequences. Doc Ophthalmol 1980;50:83–99.
Holden R, Damato BE . Preventable delays in the treatment of intraocular melanoma in the UK. Eye 1996;10:127–9.
Manschot WA, van Perperzeel HA . Choroidal melanoma: enucleation or observation? A new approach. Arch Ophthalmol 1980;98:71–7.
Zimmerman LE, McLean IW, Foster, WD . Does enucleation of the eye containing a malignant melanoma prevent or accelerate the dissemination of tumour cells? Br J Ophthalmol 1978;62:420–5.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ah-Fat, F., Damato, B. Delays in the diagnosis of uveal melanoma and effect on treatment. Eye 12, 781–782 (1998). https://doi.org/10.1038/eye.1998.202
Issue Date:
DOI: https://doi.org/10.1038/eye.1998.202
Keywords
This article is cited by
-
Future perspectives of uveal melanoma blood based biomarkers
British Journal of Cancer (2022)
-
Time to treatment of uveal melanoma in the United Kingdom
Eye (2001)