Author reply

Abstract

We thank Dr. Rivoire and colleagues for their interest in our study.1 Because patients in our study had been referred to the John Wayne Cancer Institute (Santa Monica, CA) for management of metastatic melanoma, their demographic characteristics depended on referral patterns. However, the 70% rate of liver involvement in our study was comparable to the 75% rate reported in the small study conducted by Aoyama et al.2 Our study cannot be compared with the report of Gragoudas et al.,3 who enrolled patients before the diagnosis of metastatic disease. However, we should point out that patients in that study were treated between 1975 and 1986, a period that covers some of the earlier years of our review. Therefore, their higher incidence of liver metastases cannot be explained by the use of more current imaging techniques. Because our study cohort consisted of patients with established metastases, no conclusions can be drawn based on the characteristics of the primary tumor. There was no control group of patients with nonmetastatic ocular melanoma for comparison. As stated previously, our study was a retrospective analysis of prospectively collected clinical data. The criteria used to determine surgical versus nonsurgical treatment were not available. However, statistical analysis allowed us to identify 3 criteria that might be considered when selecting candidates for surgical resection: a disease-free interval > 45 months, fewer than 5 metastatic lesions, and no other evidence of disease. We agree with Dr. Rivoire and colleagues that the literature contains few reports on surgical resection of metastases from an intraocular primary melanoma and very little information on the management of hepatic metastases from this type of primary malignancy. The 75% rate of hepatic metastases reported by Aoyama et al.2 represented only 9 patients (from a cohort of 12). In the absence of large prospective studies, which remain impractical for this patient population, our findings serve two purposes. First, they underscore the importance of considering surgical intervention for metastatic disease. Second, they emphasize the urgent need for more effective systemic therapies.