Manschot W A, Lee W R, van Strik R
Institute of Pathology, Erasmus University, Rotterdam, The Netherlands.
Int Ophthalmol. 1995;19(4):203-9. doi: 10.1007/BF00132688.
Published data on growth rates of uveal melanomas and effects of treatment modalities raise important considerations. Dissemination from uveal melanomas starts after the tumour is larger than 7 mm diameter; growth from 7 to 10 mm diameter increases the risk of metastases incrementally to approximately 16%. Estimations of tumour doubling times indicate that metastatic death before 8 years is nearly always due to pre-therapeutic dissemination so that the impact on survival by therapy can only be assessed thereafter. Histopathology on irradiated melanomas reveals that reproductive activity has not been suppressed and the anticipated (and unfavourable) risk of metastases is not balanced by poor post-irradiation visual acuity. Also the psychological well-being of a patient with a functional fellow eye is better after primary enucleation. Conservative management is most appropriate for: small melanomas, patients with a short life expectancy, melanomas in a single functioning eye, and patients refusing enucleation.
关于葡萄膜黑色素瘤生长速率及治疗方式效果的已发表数据引发了重要思考。葡萄膜黑色素瘤在肿瘤直径大于7毫米后开始扩散；直径从7毫米增长到10毫米会使转移风险逐步增加至约16%。肿瘤倍增时间的估计表明，8年前的转移性死亡几乎总是由于治疗前的扩散，因此只有在此之后才能评估治疗对生存的影响。照射后黑色素瘤的组织病理学显示，生殖活性并未受到抑制，且照射后视力不佳并不能平衡预期的（且不利的）转移风险。此外，保留一只功能正常眼睛的患者在进行原发眼球摘除术后心理状态更好。保守治疗最适用于：小黑色素瘤、预期寿命短的患者、单眼功能正常的黑色素瘤患者以及拒绝眼球摘除术的患者。
