Endoresectiopn of uveal melanoma without radiotherapy

Summary Endoresection of choroidal melanoma without neoadjuvant radiotherapy is controversial because of concerns about iatrogenic local tumor seeding and systemic metastases. However, several authors have reported that local tumor recurrence and seeding are rare. Further, there is no evidence that metastatic disease is increased following endoresection. Recent insights into uveal melanomas indicates that metastasis depends on the genetic tumor profile and not on surgical interventions. It would seem, therefore, that the large majority of patients experiencing ocular morbidity from neoadjuvant radiotherapy are doing so unnecessarily. This problem persists because those favoring neoadjuvant radiotherapy are skeptical of the results published by authors who hold a different view from their own. There is scope for randomized clinical trials of endoresection with and without neoadjuvant radiotherapy. If the required equipoise for such trials is lacking, an ethical way should be found to allow independent inspectors to review original patient case notes and verify all the scientific claims that neoadjuvant radiotherapy is unnecessary.