Practical management of small melanocytic lesions

Purpose In 2009 we have performed a retrospective study of 368 small uveal melanoma ( diameter less than 12 thickness less than 3 mm) Overall survival at 5 years was 92%and at 10 years 78% survival without metastasis at 5 years was 96% and at 10 years 93%. According to our data the smallest tumor associated with metastatic death was 5mm in diameter and 1,5 mm in thickness and 14 of the tumors had a diameter of less than 10 mm developed. Half of the metastatic patients developed metastasis 5 years or more after treatment. Methods According to the study performed by Gass and Shields the risk factors for growth of small melanocytic lesions are the presence of symptoms, subretinal fluid,proximity of ON , orange pigment , thickness of more than 2mm and diameter of more than 7 mm. Performing genetic test on small melanocytic lesions is not always usefull , as it has been shown that a good prognosis lesion can grow and change in a bad prognosis. Results Ophthalmologists are always trying to preserve vision as a rule. Nevertheless with possibly malignant lesions, the metastatic risk has to be considered before a therapeutic approach is decided. Factors like age of the patient, number of risk factors for growth and location of the tumor should be taken in account. Thus the practician should advise the patient and discuss and explain the decision. Conclusion We usually recommend treatment if there are at least two risk factors and if the patient is young and the lesion away from the posterior pole.In all different situations we usually recommend close follow up for suspicious lesions and treatment in case of documented growth.