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. 2022 Apr;106(4):510-517.
doi: 10.1136/bjophthalmol-2020-317949. Epub 2021 Jan 15.

Patients presenting with metastases: stage IV uveal melanoma, an international study

Gaurav Garg  1 , Paul T Finger  2 , Tero T Kivelä  3 , E Rand Simpson  4 , Brenda L Gallie  5 , Svetlana Saakyan  6 , Anush G Amiryan  6 , Vladimir Valskiy  6 , Kimberly J Chin  1 , Ekaterina Semenova  1 , Stefan Seregard  7 , Maria Filì  7 , Matthew Wilson  8 , Barrett Haik  8 , Josep Maria Caminal  9 , Jaume Catala-Mora  9 , Cristina Gutiérrez  9 , David E Pelayes  10 , Anibal Martin Folgar  10 , Martine Johanna Jager  11 , Mehmet Doğrusöz  11 , Gregorius P M Luyten  11 , Arun D Singh  12 , Shigenobu Suzuki  13 ; AJCC Ophthalmic Oncology Task Force
Collaborators, Affiliations

Patients presenting with metastases: stage IV uveal melanoma, an international study

Gaurav Garg et al. Br J Ophthalmol. 2022 Apr.

Abstract

Objective: To analyse ocular and systemic findings of patients presenting with systemic metastasis.

Methods and analysis: It is an international, multicentre, internet-enabled, registry-based retrospective data analysis. Patients were diagnosed between 2001 and 2011. Data included: primary tumour dimensions, extrascleral extension, ciliary body involvement, American Joint Committee on Cancer (AJCC)-tumour, node, metastasis staging, characteristics of metastases.

Results: Of 3610 patients with uveal melanoma, 69 (1.9%; 95% CI 1.5 to 2.4) presented with clinical metastasis (stage IV). These melanomas originated in the iris, ciliary body and choroid in 4%, 16% and 80% of eyes, respectively. Using eighth edition AJCC, 8 (11%), 20 (29%), 24 (35%), and 17 (25%) belonged to AJCC T-categories T1-T4. Risk of synchronous metastases increased from 0.7% (T1) to 1.5% (T2), 2.6% (T3) and 7.9% (T4). Regional lymph node metastases (N1a) were detected in 9 (13%) patients of whom 6 (67%) had extrascleral extension. Stage of systemic metastases (known for 40 (59%) stage IV patients) revealed 14 (35%), 25 (63%) and 1 (2%) had small (M1a), medium-sized (M1b) and large-sized (M1c) metastases, respectively. Location of metastases in stage IV patients were liver (91%), lung (16%), bone (9%), brain (6%), subcutaneous tissue (4%) and others (5%). Multiple sites of metastases were noted in 24%. Compared with the 98.1% of patients who did not present with metastases, those with synchronous metastases had larger intraocular tumours, more frequent extrascleral extension, ciliary body involvement and thus a higher AJCC T-category.

Conclusions: Though higher AJCC T-stage was associated with risk for metastases at diagnosis, even small T1 tumours were stage IV at initial presentation. The liver was the most common site of metastases; however, frequent multiorgan involvement supports initial whole-body staging.

Keywords: Iris; choroid; ciliary body; imaging; retina.

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Conflict of interest statement

Competing interests: None declared.

References

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