Totally necrotic choroidal and ciliary body melanomas: Associations with prognosis, episcleritis, and scleritis

PURPOSE: To report associations between prognosis, total tumor necrosis, sc leritis, and episcleritis in choroidal and ciliary body melanomas. METHODS: In this retrospective observational histopathologic study, 157 tot ally necrotic melanomas and 177 melanomas that were not totally necrotic of choroidal and ciliary body were retrieved from the Registry of Ophthalmic Pathology. The eyes were examined for the histologic evidence of inflammato ry cells within the sclera and episcleral tissues. Contingency table, Kapla n-Meier, and Cox proportional hazard regression analyses were performed. In the survival analyses, only deaths with metastatic melanoma were considere d as events in the statistical analysis. RESULTS: Among the totally necrotic melanomas, 118 of 157 (75.1%) had both episcleritis and scleritis; two of 157 (1.3%) had scleritis only; 29 of 157 (18.5%) had episcleritis only; and eight of 157 (5.1%) had neither episcle ritis nor scleritis. Among the non-necrotic melanomas, 23 of 177 (12.9%) ha d both episcleritis and scleritis; eight of 177 (4.5%) had scleritis only; 71 of 177 (40.1%) had episcleritis only; and 75 of 177 (42.3%) had neither episcleritis nor scleritis. Cox regression indicated that total necrosis an d scleritis were prognostically significant (P<.05) when analyzed univariat ely but not significant when analyzed multivariately with tumor size. CONCLUSIONS: Scleritis and episcleritis were statistically significantly as sociated with total tumor necrosis. There was a higher incidence of episcle ritis than scleritis in both the necrotic and non-necrotic tumor types. Ass ociations with patient outcome were identified for necrosis and scleritis. However, these associations were statistically insignificant when the progn ostic effect of tumor size was also considered in a multivariate model. (Am J Ophthalmol 2001;131:232-236. Published by Elsevier Science Inc).