CLINICAL PROGNOSTIC FACTORS FOR SURVIVAL IN PATIENTS WITH CHOROIDAL OR CILIARY BODY MELANOMA

James J. Augsburger

Multiple retrospective and several prospective pathologic, clinico-pathologic, and clinical studies of patients with primary posterior uveal melanoma have identified the following five clinical variables as consistently significant prognostic factors for death from metastatic disease: (1) metastatic uveal melanoma, (2) extrascleral tumor extension, (3) larger tumor size, (4) ciliary body involvement by tumor, and (5) older patient age. No new clinical prognostic factors have been identified during the past 25 years. Clinical prognostic factors for death from metastatic disease in posterior uveal melanoma must be distinguished from (a) risk factors for occurrence of posterior uveal melanoma among persons in the general population, (b) differential diagnostic factors in patients with suspected posterior uveal melanoma, (c) pathologic, cytogenetic, and molecular biologic prognostic factors for survival in this disorder, and (d) clinical prognostic factors for other specified outcomes in selected subgroups of patients with posterior uveal melanoma (e.g., secondary enucleation, local tumor relapse, and blindness in patients treated initially by a conservative therapy; and enlargement of an initially untreated tumor in patients with suspected posterior uveal melanoma and managed by observation). Although pathologic, cytogenetic and molecular biologic prognostic factors would be helpful for therapeutic decision-making and follow-up planning, variables of these types are not usually available prior to treatment of clinically diagnosed posterior uveal melanomas or following treatment of such tumors by the most commonly employed conservative treatments. Fine-needle aspiration biopsy hold promise as a minimally invasive procedure that can provide tumor specimens suitable for assessment of selected cytopathologic, cytogenetic, and molecular biologic prognostic factors prior to or at the time of initial tumor treatment.


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