Choroidal melanoma. Enucleation or observation? A new approach.

Application of the knowledge of growth rate of malignant neoplasms on choroidal melanomas shows that (1) fatalities within two years after enucleation only exceptionally can be due to dissemination of tumor cells during enucleation because the growth rate of uveal melanomas generally is far too low; (2) the apparent relationship between enucleation and death by metastasis actually is a relationship in time between diagnosis of the primary tumor and death by metastasis; (3) simultaneous diagnosis of the primary tumor and its metastases rarely is possible; (4) long intervals between enucleation and death by metastasis are explained by a low growth rate of metastases. Early enucleation, especially of small melanomas, is obligatory, because it prevents (further) dissemination of tumor cells. Preoperative local radiotherapy of two doses of 400 rads each will devitalize about 90% of the primary cells and largely will prevent possible iatrogenic dissemination.