title: Uveal melanoma in the Saudi Arabian population: Two decades of management at the King Khaled Eye Specialist Hospital.
abstract: OBJECTIVE
  To present the experience of King Khaled Eye Specialist Hospital (KKESH) with uveal melanoma over the last two decades in a fashion similar to the result of the Collaborative Ocular Melanoma Study (COMS).
  
  
  METHODS
  Retrospective, non-comparative, interventional, case series.
  
  
  METHODS
  All patients were diagnosed with uveal melanoma at the King Khaled Eye Specialist Hospital (KKESH), Riyadh, Saudi Arabia from June 1983 to July 2005 and met the inclusion criteria of the COMS.
  
  
  METHODS
  A medical record review of clinical history, imaging studies, surgical procedures and treatment outcome was performed.
  
  
  RESULTS
  Forty patients (24 males and 16 females) with uveal melanoma (average age 50 years; range 24-77 years) were included in the study; 28 (70%) were of Saudi Arabian descent and the remaining 12 (30%) patients were from neighboring Arab countries. Decreased vision was the main presenting complaint of 29 (72.5%) patients; the duration of this symptom was 3 months or more in 27 (67.5%) patients. The apical height of the tumor was 10 mm or more in nine (22.5%) of the affected eyes and the largest basal dimension was more than 16 mm in nine (22.5%) of the affected eyes. The posterior border of the tumor was 1-2 mm from the optic disc in three (7.5%) affected eyes. Primary enucleation was performed for 33 (82.5%) eyes, episcleral radiation plaque therapy for six (15%) of the eyes and endo resection of the uveal melanoma in one (2.5%) eye. Adjunct external beam radiation therapy was performed in two (5%) orbits for extrascleral extension. The histopathological diagnosis was available for 34 (84%) eyes in which surgery had been performed (33 patients underwent primary enucleation and one patient underwent endo resection of the uveal melanoma); 24 (70.6%) eyes had spindle cell and the remaining 10 (29.4%) had epithelioid or mixed cell types. Evidence of extraocular tumor extension was found in three eyes. The average follow-up was 33.7 months with a median of 19 months (range 0.5 months to 10 years). Two (5%) patients developed metastasis after 2 years and 5 years from the initial treatment of large and medium-sized uveal melanomas, respectively.
  
  
  CONCLUSIONS
  Individuals of Saudi Arabian ancestry appear to have a low incidence of uveal melanoma. Further studies are required to estimate the true incidence of uveal melanoma in the larger Arab population. Early detection is essential for improving the patient outcomes. Regular communication between the tertiary care eye centers and the local ophthalmic care providers is required to enhance the understanding about uveal melanoma behavior in Arab population.
authors: Department of Ophthalmology, King Abdulaziz University Hospital, King Saud University, P.O. Box 245, Riyadh 11411, Saudi Arabia.
authors: Adel H
authors: AH
authors: Alsuhaibani
keywords: Choroidal melanoma; Enucleation; King Khaled Eye Specialist Hospital; Plaque radiotherapy; Saudi Arabia; Uveal melanoma
references: Arch Ophthalmol. 2001 Jul;119(7):951-65
references: 11448318
references: Am J Ophthalmol. 1998 Jun;125(6):745-66
references: 9645714
references: Arch Ophthalmol. 2001 May;119(5):670-6
references: 11346394
references: Arch Ophthalmol. 2006 Dec;124(12):1684-93
references: 17159027
references: Arch Ophthalmol. 1990 Sep;108(9):1268-73
references: 2205183
references: Ophthalmol Clin North Am. 2005 Mar;18(1):129-42, ix
references: 15763198
references: Surv Ophthalmol. 1996 Nov-Dec;41(3):215-28
references: 8970236
references: JAMA. 1982 Oct 15;248(15):1856-9
references: 7120604
references: Arch Ophthalmol. 2002 May;120(5):676
references: 12003636
references: Arch Ophthalmol. 2001 Jul;119(7):969-82
references: 11448319
references: Ophthalmology. 1990 Sep;97(9):1143-7
references: 2234844
references: Arch Ophthalmol. 1981 Dec;99(12):2133-6
references: 7305710
references: Arch Ophthalmol. 1992 Feb;110(2):245-50
references: 1531290
references: Invest Ophthalmol Vis Sci. 1980 Jul;19(7):760-70
references: 7390722
references: Int Ophthalmol Clin. 1982 Fall;22(3):57-71
references: 7107133
references: Arch Ophthalmol. 2005 Dec;123(12):1639-43
references: 16344433
references: Ophthalmology. 1980 Jun;87(6):549-56
references: 7413144
references: Cancer. 1999 Mar 1;85(5):1151-9
references: 10091801
references: Am J Ophthalmol. 1983 Oct;96(4):502-9
references: 6624832
references: Arch Ophthalmol. 1984 Jan;102(1):77-9
references: 6703971
references: Control Clin Trials. 1993 Oct;14(5):362-91
references: 8222668
references: J Clin Oncol. 2004 Jun 15;22(12):2438-44
references: 15197206
references: J Natl Cancer Inst. 1976 Mar;56(3):489-91
references: 1255781
references: Am J Ophthalmol. 2005 Oct;140(4):612-7
references: 16226513
references: Ophthalmology. 2003 May;110(5):962-5
references: 12750098
references: Int Ophthalmol. 1992 Mar;16(2):91-9
references: 1587700
references: Ophthalmology. 2001 Feb;108(2):348-66
references: 11158813
references: Arch Ophthalmol. 1997 Dec;115(12):1537-44
references: 9400787
references: J Natl Med Assoc. 1995 Sep;87(9):709-14
references: 9583969
references: Arch Ophthalmol. 1997 Jul;115(7):886-93
references: 9230829
references: Ann Surg. 1976 May;183(5):533-42
references: 1275593
references: Am J Ophthalmol. 1998 Jun;125(6):779-96
references: 9645716