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

Garg, Gaurav, Finger, Paul T, Kivela, Tero T, Simpson, E Rand, Gallie, Brenda L, Saakyan, Svetlana, Amiryan, Anush G, Valskiy, Vladimir, Chin, Kimberly J, Semenova, Ekaterina
et al (show 14 more authors) (2022) Patients presenting with metastases: stage IV uveal melanoma, an international study. BRITISH JOURNAL OF OPHTHALMOLOGY, 106 (4). pp. 510-517.

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<h4>Objective</h4>To analyse ocular and systemic findings of patients presenting with systemic metastasis.<h4>Methods and analysis</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.

Item Type: Article
Uncontrolled Keywords: choroid, ciliary body, Iris, retina, imaging
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User: Symplectic Admin
Date Deposited: 28 Sep 2023 10:07
Last Modified: 28 Sep 2023 10:07
DOI: 10.1136/bjophthalmol-2020-317949
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