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  • Risk of observation vs. immediate treatment for small choroidal melanocytic tumors

    Ocular Pathology/Oncology

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    Review of: Small choroidal melanoma: Outcomes after surveillance versus immediate treatment

    Singh A, Raval V, Wrenn J, et al. American Journal of Ophthalmology, September 2022


    Investigators compared the outcomes of immediate treatment of low-risk small choroidal melanocytic tumors versus treatment after further tumor growth was observed and found no higher risk of metastasis in the observation-first cases.

    Study design

    This retrospective study includes a total of 167 patients with small choroidal melanoma treated between January 2010 and January 2019. The patients were divided into 2 groups based on timing of treatment. Patients in the immediate treatment group (125 patients) underwent immediate treatment based on established clinical criteria. The tumors in this group were further classified into low-risk melanoma (31) and high-risk melanoma (94). Patients in the surveillance group (42 patients) underwent initial observation followed by treatment after documented tumor growth. The patients in the low-risk immediate treatment group were compared with the patients in the surveillance group with regard to risk of vision loss and metastasis.

    Outcomes

    Loss of <15-letter visual acuity (VA) was not significantly different at 36 months between the low-risk immediate treatment group and the surveillance group (81% vs 83%). Metastasis developed in one patient in each group.

    Limitations

    As the authors state, this retrospective study suffers from limitations regarding number of studied patients and duration of follow-up. In addition, due to the non-randomized nature of the study, there could be differences between the clinical findings of the two comparison groups that could affect the outcomes of VA loss and metastasis.

    Clinical significance

    The optimal method of management of low-risk small melanocytic choroidal tumors is a controversial topic. Some experts support immediate treatment to reduce risk of future tumor metastasis, while others recommend initial observation and documentation of tumor growth before treatment, with the goal of preventing unnecessary treatments and their associated complications. The findings of this study, though not conclusive, support the approach that initial observation of low-risk small choroidal melanocytic tumors to document growth before treatment will not predispose patients to higher risk of metastasis.