Does delayed treatment shorten the life of patients with fatal choroidal melanoma?

Abstract

Abstract Purpose Metastatic death from uveal melanoma occurs in about 50% of patients many of whom experience a delay in treatment, either intentionally or accidentally. The aim of this study was to determine whether treatment delay shortens survival in patients with choroidal melanoma whose disease apparently proved fatal. Methods Patients with choroidal melanoma were included in the study if resident in mainland Britain and if deceased. Survival was analysed according to basal tumour diameter by Kaplan‐Meier and Log rank analysis. Results A total of 696 patients with choroidal melanoma died. The patients had a median age of 65 years and a median basal tumour diameter of 15.0 mm. The basal tumour diameter was <10mm in 41 patients; 10‐11mm in 88; 12‐13mm in 108; 14‐15mm in 165; 16‐17mm in 123; and >17mm in 171 patients. Log‐rank analysis showed no correlation between survival and basal tumour diameter in these patients (Log rank analysis, p = 0.5537). There was perhaps a trend towards longer survival in patients with a basal tumour diameter less than 10mm. Conclusion In patients with fatal uveal melanoma, there is no significant correlation between basal tumour diameter and survival time. Delay in treatment does not seem to worsen prognosis for survival significantly, except perhaps in patients with small tumours. This finding adds further support to the concept that the main objective of ocular treatment is to conserve the eye with as much useful vision as possible. Since ocular treatment can itself cause significant visual loss, the benefit of treating asymptomatic uveal melanomas is uncertain. There is scope for randomized, prospective studies of treatment versus non‐treatment of patients with asymptomatic choroidal melanoma.