Time to treatment of uveal melanoma in the United Kingdom

Purpose To measure delay before treatment of uveal melanoma. Methods A retrospective study was carried out of patients referred for diag nosis and treatment of uveal melanoma at the Liverpool Ocular Oncology Cent re (LOOC), a tertiary adult ocular oncology service. Participants were pati ents with uveal melanoma presenting to an optometrist or general practition er in the United Kingdom between 1997 and 2000. Main outcome measures were delay at each stage of the referral process according to route of referral and tumour size. Results Delays greater than 2 weeks occurred (1) between presentation to th e optometrist or general practitioner and the ophthalmologist's examination in 50% of patients; (2) between the ophthalmologist's examination and rece ipt of the referral at the ocular oncology centre in 34%; (3) between recei pt of referral at the oncology centre and first assessment at that centre i n 16%; and (4) between first assessment at the oncology centre and treatmen t in 8%. The waiting time for the ophthalmologist's examination was greater if the optometrist referred the patient via the general practitioner inste ad of directly. The median overall delays between presentation and treatmen t were 129 days for small tumours, 50 days for medium-sized tumours and 34 days for large tumours. Conclusions Many patients with uveal melanoma experience long delays before treatment. Patients wait longer to see an ophthalmologist if their tumour is small or if they are referred by the optometrist to the general practiti oner instead of directly to the ophthalmologist. Several patients also expe rience long delays after seeing the ophthalmologist, some having a large tu mour by the time of teatment.