Clinical and histopathological aspects of 113 necrotizing malignant melanomas of the choroid. 1. Clinical and histopathological features of necrotizing choroidal melanomas

Background Tumor necrosis may reflect a destructive immune reaction. System atic and statistically significant comparative clinico-histopathologic stud ies have not yet been reported. Patients and Methods 113 necrotizing choroidal melanomas (NCM) recruited fr om 701 enucleated globes 1967-1988 were resectioned, stained and compared t o 100 choroidal melanomas without necrosis (CM), and data of 74 patients wi th a follow-up of more than 10 years were evaluated. Results Statistically significant chracteristics of NCM were: patient age < 60 yrs. for NCM 27.4%, CM 46%; patient age in men for NCM was 64 yrs on av erage (CM: 58 yrs.), in women for NCM 67 yrs. (CM: 59 yrs.). Time elapsed b etween first symptoms and enucleation was < 12 months in 15.9% of NCM (89% for CM). and >12 months in 23.9% of NCM (11% in CM). Mixed or epitheloid ce ll tumors was seen in 54.9% of NCM and 49% of CM, spindle cell tumors in 36 .3% of NCM and 51% in CM. Advanced tumor stages T3 and T4 were present in 4 5.1% resp. 36.3% of NCM compared to 37% resp. 16% in CM. Scleral invasion w as documented in 67.3% of NCM and 37% of CM, extrascleral dissemination in 43% of NCM and 16% of CM. Secondary glaucomas were seen in 62.2% of NCM and 6% CM, a penetration through Bruch's membrane in 61.0% of NCM and 46% of C M. Intratumoral hemorrhage was noted in 68.14% of NCM and 24% of CRI, extra tumoral bleeding in 23.9% of NCM and 0% CM. Inflammatory reactions in tumor s were observed in 96.7% of NCM harboring >30% necrosis compared to 5% in C M, and extratumoral in 94.5% of NCM and 0% of CM. Intraocular extratumoral necrosis was seen in 23.9% of NCM and 0% of CM. There were no significant d ifferences in the degree of pigmentation of the 90.3% pigmented NCM or of t he 94% pigmented CM, neither in the tumor localization, being constantly be hind the equator in 87% of cases. Survival of patients with NCM patients wa s 5 yeas and 9 months on average (5-year mortality rate 41.9%), and 74.3% w ere deceased from metastatic spread. Conclusions Significant clinical and histopathological differences between necrotizing and non-necrotizing malignant melanomas of the choroid can be i dentified. The inflammatory reaction of NCM must be further elucidated, par ticularly with respect to the nature of tumor-infiltrating lymphocytes.