What is the prognosis of choroidal melanoma?

Updated: Feb 18, 2020
  • Author: Enrique Garcia-Valenzuela, MD, PhD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Visual prognosis is guarded for choroidal melanomas. Choroidal melanoma normally leads to partial or total visual loss in the affected eye. This is the result of either tumor destruction of ocular structures or consequence to the treatment used. Patients with small- to medium-sized choroidal melanomas may be able to preserve very good central vision, even after treatment. [2]

Choroidal melanoma is a disease with a high mortality rate, usually irrespective of the chosen treatment modality. About 30-50% of patients with choroidal melanoma will die within 10 years from diagnosis and treatment. Death is usually secondary to distant metastases, and the risk is greatest in larger tumors.

For large melanomas, the Collaborative Ocular Melanoma Study found that the 10-year rates of death secondary to metastasis were 45% in the pre-enucleation radiation group and 40% in the enucleation alone group. There appears to be no survival benefit attributable to pre-enucleation radiation. The maximum diameter of the base of the tumor and older age were the primary predictors of time to death in patients with melanoma metastasis.

Previous publications have found several tumor features to correlate with increased mortality, including larger size, anterior location, transscleral extension, growth through the Bruch membrane, optic nerve extension, lack of pigmentation, and histologic characteristics (eg, mitotic activity and cell type). [18] Although metastases from the primary intraocular melanoma can first be detected years later, their highest incidence is in the first year after diagnosis. As yet, no effective treatment exists for metastatic uveal melanoma.

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