Malignant melanomas of the human uvea: 25-year follow-up of cases in Denmark, 1943--1952.

All cases (302) of malignant intraocular melanomas in Denmark between 1943--1952 were followed up and evaluated 25 years after enucleation, which was the treatment used immediately after diagnosis during that period. The follow-up percentage was 99, 82% of the total being dead at the time of follow-up, bringing the real course of the malignant uveal melanoma in a traditionally treated series nearer to the truth. The same series was analysed in 1963 and 1970. Three-quarters of the patients were hospitalized immediately before and/or in the process of dying. In the series of choroidal and/or ciliary body melanoma the autopsy frequency was 36. Death with metastases took place in 51% (150). Orbital recurrence was found in 2.5% and 8--12% of cases with extrascleral extension had orbital recurrence. This appeared at an average of 2 years after enucleation and 10% of metastases appeared within the first 6 months post-operatively, more than half within 3 years. The peak incidence was during the first year after enucleation. No second peak was observed. However, metastases appeared even after 23 years. The probability of being alive without metastases after 25 years was found to be 40%, assuming that the patient did not die of another cause. The prognosis was estimated using various clinical and histopathological parameters. Women below the age of 40 had a better prognosis than women above that age. Small tumours, spindle shaped cells, no invasion and low pigment content of tumour were all in favour of a good prognosis. Of the iris melanomas from the period dealt with, only one died with metastasis. The present lively discussion on early enucleation or conservative management is reported and finally the attitude of the Ophthalmic Tumour Centre towards therapy is indicated.