title: Uveal melanoma and poor treatment compliance: an atypical outcome with literature review.
abstract: BACKGROUND
  A uveal melanoma is the most common primary intraocular malignancy and is the primary intraocular disease that can be fatal in adults. Until recently, data were limited regarding growth characteristics and at what stage metastases are likely to occur.
  
  
  METHODS
  A 49-year-old white male presented on January 19, 1989, for a second opinion regarding a spot that had been discovered in the right eye 13 months prior. Ophthalmologic evaluation and echography were consistent for a uveal melanoma of 5 mm elevation and 13.5 x 6 mm in diameter. The patient refused treatment or enrollment into the Collaborative Ocular Melanoma Study. On December 9, 1991, the eye was enucleated with a modified exenteration due to severe proptosis, tumor thickness of 22 mm, and three areas of extrascleral extension. The patient refused postoperative radiation treatment and refused clinical follow-up. This case was reviewed from the initial evaluation date through the last clinical visit. The patient was recently interviewed with respect to his use of homeopathic medicine, change in lifestyle, and the effect he felt it might have had on his life.
  
  
  CONCLUSIONS
  The literature published by the Collaborative Ocular Melanoma Study regarding the histopathologic characteristics of eyes enucleated and the initial mortality findings of a large choroidal melanoma indicate that this is a most unusual case. The patient has defied the mortality findings of the most recent and largest study to date (mean survival rate, 82 months). The patient is still alive 181 months after the original finding of the lesion and refusal of advised treatment recommendations in favor of homeopathic medicine.
authors.affiliation: The Wilmer Ophthalmological Institute, The Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA. wpark@jhmi.edu
authors.forename: William L
authors.initials: WL
authors.lastname: Park
authors.forename: Tamara
authors.initials: T
authors.lastname: Jenison-Williams
authors.forename: Tommasina
authors.initials: T
authors.lastname: Pasqua-Darnell
mesh_terms: D001918:Brachytherapy; D003952:Diagnostic Imaging; D018572:Disease-Free Survival; D015353:Eye Enucleation; D006801:Humans; D008297:Male; D008419:Materia Medica; D008545:Melanoma / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011182:Postoperative Care; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D040242:Risk Reduction Behavior; D015996:Survival Rate; D016312:Treatment Refusal; D014604:Uveal Neoplasms / Q000175:diagnosis / Q000601:surgery*
chemical_list: D008419:Materia Medica