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

Gaurav Garg, Paul T. Finger, Tero T. Kivelä, Rand Simpson, Brenda L. Gallie, Svetlana Saakyan, Anush G. Amiryan, Vladimir Valskiy, Kimberly J. Chin, katerina Semenova, Stefan Seregard, Maria Filì, Matthew Wilson, Barrett Haik, Josep Maria Caminal, Jaume Catala-Mora, Cristina Gutiérrez, David E. Pelayes, Anibal Martin Folgar, Martine Johanna JagerMehmet Doǧrusöz, Gregorius P.M. Luyten, Arun D. Singh, Shigenobu Suzuki

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

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.

Original languageEnglish
Pages (from-to)510-517
Number of pages8
JournalBritish Journal of Ophthalmology
Volume106
Issue number4
DOIs
StatePublished - 1 Apr 2022
Externally publishedYes

Keywords

  • Iris
  • choroid
  • ciliary body
  • imaging
  • retina

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