UVEAL MELANOMA - UPDATED CONSIDERATIONS ON CURRENT MANAGEMENT MODALITIES

Published data on growth rates of uveal melanomas and effects of treat ment modalities raise important considerations. Dissemination from uve al melanomas starts after the tumour is larger than 7 mm diameter; gro wth from 7 to 10 mm diameter increases the risk of metastases incremen tally to approximately 16%. Estimations of tumour doubling times indic ate that metastatic death before 8 years is nearly always due to pre-t herapeutic dissemination so that the impact on survival by therapy can only be assessed thereafter. Histopathology on irradiated melanomas r eveals that reproductive activity has not been suppressed and the anti cipated (and unfavourable) risk of metastases is not balanced by poor post-irradiation visual acuity. Also the psychological well-being of a patient with a functional fellow eye is better after primary enucleat ion. Conservative management is most appropriate for: small melanomas, patients with a short life expectancy, melanomas in a single function ing eye, and patients refusing enucleation.