Uveal melanoma is the most common primary intraocular tumor that develops in adults. Of all cases of melanoma in the United States, about 5% originate in the ocular and adnexal structures.
And of these, most originate in the uvea, said Arun D. Singh, MD, director, Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland. Dr. Singh and colleagues conducted a study to identify trends in the incidence, treatment, and survival rates associated with uveal melanoma. The authors published their results in Ophthalmology (2011;118:1881–1885).
Patients with uveal melanoma underwent enucleation, radiation, and other treatments that resulted in 5-year survival rates ranging from 25% to 66%.
"As newer therapies develop, and as our ability to guide treatment based on metastatic risk profile evolves, it will become increasingly important to track the treatment modality and survival rates in patients with uveal melanoma," the authors said.
In order to determine the age-adjusted incidence, the effects of changing treatment strategies, and the survival rates of patients with uveal melanoma, Dr. Singh and colleagues conducted a systematic review of existing data in the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute from 1973 to 2008. The main outcome measures were the age-adjusted incidence; the form of treatment (i.e., surgery, radiation, or both); and 5-year relative survival rates.
The authors reported that of 131,723 cases of melanoma in the SEER database during the period covered by the study, 3.8% of cases were ocular/adnexal melanoma; of those, 4,070 cases (81.4%) were uveal melanoma. An almost equal number of men and women had uveal melanoma. The median patient age at diagnosis was 62 years (range, 6 to 100 years). The vast majority (97.8%) of uveal melanoma cases were seen in Caucasian individuals. Most patients (88.4%) had not had a previous malignancy.
"The overall mean age-adjusted incidence of uveal melanoma in the United States over the 36-year period from 1973 to 2008 was 5.1 per million (95% CI [confidence interval], 4.8–5.3). Male subjects had a significantly higher age-adjusted incidence of 5.8 per million (95% CI, 5.5–6.2) compared with female subjects with an average age-adjusted incidence of 4.4 (95% CI, 4.2–4.7). The overall age-adjusted incidence of uveal melanoma did not change significantly between 1973 and 2008," the authors reported.
The use of radiation as a treatment for uveal melanoma increased during the later years of the study. While during the period from 1973 to 1975, 93.8% of patients underwent only a surgical intervention, the percentage decreased to 28.3% from 2006 to 2008. The use of radiation increased from 1.8% of cases in 1973 to 1975 to 62.5% of cases during the period between 2006 and 2008. However, despite this, the 5-year relative survival rate (81.6%) did not change from 1973 to 2008.