Montgomery Lecture, 1975. Changing concepts of the prognosis and management of small malignant melanomas of the choroid.

Recent studies have shown conclusively that patients with small choroidal melanomas tend to have a favourable prognosis and that this, in turn, is closely related to tumour cell type, mitotic activity, degree of trans-scleral extension, and other characteristics of the tumour. It has not yet been established whether enucleation of the tumour-containing eye increases or decreases the patient's chance for survival. The frequency with which we observe late metastatic deaths among patients who had seemingly been 'cured' by enucleation indicate that host factors are most important in determining whether or not a patient will succumb to his tumour. It is possible that nonsurgical methods of treatment may be as effective or even more effective than enucleation (a) by diminishing the changes of intravasation of tumour cells, and (b) by promoting a more favourable host response to the tumour. While the total experience in management by methods other than enucleation is small, the results reported to date with photocoagulation, radiation, and no therapy are encouraging. Only after a much larger experience with prolonged periods of evaluation (more than 10 years after recognition of the tumour) will we be able to compare the results with those obtained by enucleation.