Metastatic disease from untreated uveal melanomas.

Few ophthalmologists or pathologists have observed uveal melanomas that metastasized before they were recognized and treated. In an effort to characterize those melanomas that have produced metastatic disease before the tumor-containing eye was enucleated, we have collected a series of 29 cases for review. These have generally involved older subjects (median age 65 years) who had large tumors that had been symptomatic for long periods before being recognized. A disproportionately large percentage showed extraocular extension. Although the data support the thesis that uveal melanomas are typically slow-growing tumors that show local infiltrative properties but little tendency to produce metastatic disease unless treated by enucleation of the eye, it is possible that the available information is possibly biased by our methods of acquisition of data. Much pertinent information is lost because the cases usually do not come to the attention of ophthalmologists or ophthalmic pathologist. This missing link in our knowledge of the natural course of untreated uveal melanomas is one of several factors that make it impossible to determine whether the overall effects of enucleation have been beneficial or harmful in the management of this disease.