Nondiagnosed uveal melanomas.

Abstract

To determine the proportion of nondiagnosed uveal melanomas after evaluation by optometrists or ophthalmologists. Retrospective observational cohort study. Four hundred thirty-three ophthalmic oncology patients with uveal melanoma. This was a retrospective study of uveal melanoma patients from a single ophthalmic oncology center. We sent questionnaires to living patients we had treated between 1980 and 2000 for uveal melanoma. Patients were divided into those who had an examination within 1 year before diagnosis of a melanoma in which the tumor was not detected, those patients who were being observed with a known pigmented uveal tumor, and those who had not had an eye examination for at least 10 years. The detection of unsuspected melanomas. We determined that 37% of patients referred to us with a newly discovered uveal melanoma had been examined within a year, without a uveal melanoma being detected. Of patients whose medical records were obtained, 71% had eyes that had been dilated and the tumor not found. The patients in whom the tumors were nondiagnosed within 1 year of referral to us had a mean tumor thickness of 6 mm and a mean tumor diameter of 12 mm. Ninety percent of the tumors were partially posterior to the equator. Patients who had been observed by their outside ophthalmologist with a choroidal pigmented tumor had significantly smaller tumors (P<0.005). There are a notable number of patients seen by general ophthalmologists with symptomatic uveal melanomas in whom the diagnosis is not established. It is likely that screening efforts for this relatively rare condition are often not efficacious.