Uveal melanoma secondary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
Secondary prevention strategies following uveal melanoma include [strategy 1], [strategy 2], and [strategy 3].
Secondary Prevention
Currently, there is no consensus regarding type or frequency of scans following diagnosis and treatment of the primary eye tumor. Of the 50% of patients who develop metastatic disease, more than 90% of patients will develop liver metastases. As such, the majority of surveillance techniques are focused on the liver. These include abdominal magnetic resonance imaging (MRI), abdominal ultrasound and liver function tests.
Regardless of treatment, monitoring for metastasis should be performed regularly and patient compliance with follow-up should be stressed. Regular dilated fundus examination, liver function test, and CT or right upper quadrant ultrasound assessing liver metastasis is the follow-up performed by most ophthalmologists. The frequency of follow-up is recommended to be based on the demonstrated risk of the tumor, as discussed below, with visits every 3-4 months suggested for patient’s with the highest risk tumors. Uveal melanoma metastases may present years after the primary tumour has been treated. A patient who receives treatment (e.g. brachytherapy, EBRT, or enucleation) can still get metastases from the tumour cells that escaped from the eye to the body PRIOR to treatment.Almost 50% of patients with uveal melanoma will develop metastases within 15 years of being initially diagnosed. 2% of patients at the time of initial uveal melanoma diagnosis would show an evidence of metastases. A diagnosis of uveal melanoma metastasis has a very poor prognosis and, unfortunately, has a high rate of mortality. There are several approaches to surveillance for metastases. Because metastases usually occur in the liver and in the lung, tests that are performed are focused on these organs. These tests are performed every 6-12 months and can continue for many years or decades. However, there are no standard guidelines or approachesfor surveillance as there is no clear consensus amongst experts. • Blood tests – to determine how the liver is functioning. • Imaging tests – ultrasound to monitor the liver and a chest X-ray to monitor the lung. Some people receive Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) scans. • Physical exam – to detect issues. • Recently, gene studies, by a needle biopsy from the tumour before treatment, can predict with high accuracy the potential to develop metastases eventually.