Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.
Am J Ophthalmol. 2019 Jun;202:100-108. doi: 10.1016/j.ajo.2019.01.031. Epub 2019 Feb 15.
To determine the size at which choroidal melanomas can metastasize and to report the characteristics of small fatal choroidal melanomas (SFCM).
Retrospective case series.
Ten ocular oncology services submitted 45 patients with a choroidal melanoma 3 mm or less in thickness and 9 mm or less in largest basal diameter (LBD), when treated, who developed metastases.
Median tumor thickness was 2.4 mm (range, 1.0-3.0 mm) and LBD 7.3 mm (range, 3.0-9.0 mm). Of 14 (31%) tumors that were first observed, 12 grew a median of 0.5 mm (range, 0.1-1.2 mm) in thickness and 1.0 mm (range, 0-3.0 mm) in LBD within a median of 7 months; 3 were initially smaller than 3 mm in LBD. Number of risk factors for growth and metastasis was 0 for 4% of the tumors; 60% were over 2 mm in thickness, 63% had subretinal fluid, 84% caused symptoms, 57% had orange pigment, and 92% were within 3 mm of the disc. Local recurrence occurred in 8 of 31 eyes (26%) treated conservatively. Median metastasis-free survival was 4.5 years (range, 0.8-15.7 years). Kaplan-Meier estimate of metastasis developing was 15% (95% confidence interval [CI], 7-26), 51% (95% CI, 36-64) and 85% (95% CI, 71-92) by 2, 5, and 10 years, respectively. By the time of analysis, 37 patients had died of metastasis after a median of 7 months.
Choroidal melanomas less than 3.0 mm in LBD are highly unlikely to metastasize. Risk factors of an SFCM are similar to those for all choroidal melanomas of similar size.
确定脉络膜黑色素瘤转移的大小，并报告小的致命性脉络膜黑色素瘤（SFCM）的特征。
回顾性病例系列。
10 个眼肿瘤服务机构提交了 45 名脉络膜黑色素瘤患者的资料，这些患者的肿瘤厚度为 3mm 或以下，最大基底直径（LBD）为 9mm 或以下，在治疗时发生了转移。
中位肿瘤厚度为 2.4mm（范围，1.0-3.0mm），LBD 为 7.3mm（范围，3.0-9.0mm）。在首次观察到的 14 个（31%）肿瘤中，有 12 个肿瘤的厚度平均增加了 0.5mm（范围，0.1-1.2mm），LBD 平均增加了 1.0mm（范围，0-3.0mm），中位时间为 7 个月；3 个肿瘤最初的 LBD 小于 3mm。肿瘤生长和转移的风险因素数为 0 的占 4%；60%的肿瘤厚度超过 2mm，63%有视网膜下积液，84%引起症状，57%有橙色色素，92%位于视盘 3mm 以内。保守治疗的 31 只眼中有 8 只（26%）发生局部复发。无转移生存的中位时间为 4.5 年（范围，0.8-15.7 年）。Kaplan-Meier 估计转移的发生率分别为 15%（95%置信区间[CI]，7-26）、51%（95%CI，36-64）和 85%（95%CI，71-92），分别在 2、5 和 10 年内。截至分析时，37 名患者在中位时间为 7 个月后死于转移。
LBD 小于 3.0mm 的脉络膜黑色素瘤极不可能转移。SFCM 的危险因素与大小相似的所有脉络膜黑色素瘤的危险因素相似。
