Do growth and onset of symptoms of uveal melanomas indicate subclinical metastasis?

The currently popular thesis that metastatic disease from uveal melanoma begins at about the same time that the intraocular tumors become symptomatic, when they not only exhibit accelerated local growth, but also invade blood vessels and begin to disseminate hematogenously, has been examined in the course of a retrospective analysis of 2,627 cases of choroidal melanoma treated by enucleation over a 40-year period. During the four decades studied, the proportion of smaller tumors with less advanced clinical manifestations increased, but there was no parallel increase in survival. These data, along with the results currently being reported by others who have treated uveal melanomas by methods other than enucleation, or who have followed patients with untreated melanomas for prolonged periods, provide no support for the concept that dissemination leading to metastasis begins with the onset of clinical symptoms.