The management of small suspected choroidal melanomas often involves a period of observation before initiating potentially vision-impairing treatment. This delay can, however, lead to anxiety over the possibility of increased metastasis risk. A recent study suggests that a delay of up to 12 months before starting treatment does not significantly elevate the estimated 15-year risk of metastatic death. This indicates that postponing treatment, thereby preserving vision and quality of life, might be a viable option for certain patients.
This research involved an analysis of the electronic medical records of 24 patients (average age 68) diagnosed with small choroidal melanoma (less than 11 mm in diameter). These patients were under observation at the St. Erik Eye Hospital between May 2022 and September 2023, with their treatment deferred by at least four months. The study team used the Liverpool Uveal Melanoma Prognosticator Online v.3 (LUMPO3) model to calculate the changes in 15-year metastatic and non-metastatic death risks, based on various hypothetical scenarios. These scenarios involved different patient ages, tumor sizes, and growth rates, with treatment beginning immediately after diagnosis or delayed by 4 or 12 months.
The LUMPO3 model utilizes data from more than 4000 patients treated for uveal melanoma to provide mortality estimates. It considers known anatomic, histologic, and genetic predictors.
The study outcomes showed that for low-risk melanomas (less than 10 mm in diameter), a four-month delay in treatment did not increase the 15-year metastatic death rate for tumors with an estimated 5% yearly growth rate. Tumors with an estimated 20% yearly growth rate saw only a minor 0.3% increase. For high-risk melanomas, the estimated increases in metastatic death rates were 0.3% and 2.3% respectively. The risk increases associated with a 12-month delay were also minimal, particularly for low-risk melanomas. Smaller tumors, slower tumor growth rates, spindle-cell morphology, and absence of high-risk genetic abnormalities were linked to lower metastatic death rates.
The study does have certain limitations. The diagnosis of melanoma was based on clinical features, not histologic or genetic findings. Furthermore, the non-metastatic death rates estimated by LUMPO3 were slightly higher than those reported in the 2021 UK census, suggesting some patients with metastatic death may have been misclassified as dying from other diseases.
Nonetheless, this study’s findings imply that delaying treatment for small choroidal melanomas until tumor growth is confirmed may result in no or minimal increase in metastatic death rate. Such insights could be beneficial when advising patients with small melanocytic choroidal tumors, potentially helping to delay or prevent radiation-induced visual loss.
(Disclaimer: No financial disclosures were made by Dr. Arman Mashayekhi in relation to this study.)
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