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Controversies |

Role of Cytogenetics in Management of Uveal Melanoma

Jerry A. Shields, MD; Carol L. Shields, MD; Miguel Materin, MD; Takami Sato, MD; Arupa Ganguly, PhD
Arch Ophthalmol. 2008;126(3):416-419. doi:10.1001/archopht.126.3.416.
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Uveal melanoma is one of the few conditions diagnosed by eye care specialists that carries a guarded prognosis for life. Although most patients are apparently healthy at the time of diagnosis, 10-year tumor-related death from posterior uveal melanoma ranges from 20% to greater than 50%.13

The management of posterior uveal melanoma has been controversial. Several years ago, heated debates erupted between 2 diametrically opposed schools of thought. One group favored prompt enucleation of virtually all melanocytic uveal lesions that were suspected to be melanomas.4,5 The other group preferred observation of many small- and medium-sized tumors to document growth before initiating treatment68; they proposed that enucleation might not improve the prognosis and could even accelerate dissemination of the neoplasm.6 The philosophy of “observation until growth is documented” has prevailed in ophthalmology during the last 30 years and some highly suspicious tumors that were probably melanomas were observed without treatment. The increased use of eye-saving modalities, such as irradiation, local resection, and transpupillary thermotherapy, has not resolved the controversy.9,10

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