title: Small metastasizing choroidal melanomas.
abstract: OBJECTIVE
  Small choroidal melanomas have a better prognosis than large tumours. However, these small tumours can spread, often late in their course. The aim of the study was to analyse survival and tumour characteristics of six cases of late metastatic diseases after conservative treatment.
  
  
  METHODS
  A retrospective study was conducted at the Croix-Rousse University Hospital of Lyon among 523 patients treated between 1991 and 2010 by proton beam therapy (508) or brachytherapy with 106 (Ru/Rh) (15) for uveal melanomas. We have selected patients with small choroidal melanoma (thickness≤3 mm and diameter≤9 mm) (59 patients), who have developed hepatic metastases (six of 59).
  
  
  RESULTS
  At the time of diagnosis, median age was 57 years (range, 37-82 years). The mean tumour thickness was 2.9 mm (range 2.5-3 mm), and the mean diameter was 7 mm (5-8 mm). Orange pigment was observed in four cases, subretinal fluid was observed in two cases, and one tumour touched the optic disc. Five patients had proton beam therapy. One patient had beta brachytherapy (106 Ru/106 Rh). Average follow-up was 8.3 years (range 4.2-11.8 years). None of the six patients developed local tumour recurrence. The mean survival time after diagnosis of melanoma was 9.8 years (range, 4.9-14.6 years). The average time from treatment of primary tumour to detection of liver metastasis was 7 years (range 3.9-12 years). The mean survival time from the diagnosis of metastasis was 35.2 months (range 9-101 months). Small melanoma-related death was 0% at 3 years, 1.7% at 5 years, 5.1% at 10 years and 10.2% at 15 years in our series.
  
  
  CONCLUSIONS
  Despite a small tumoral size and an early and effective local treatment, six of 59 small choroidal melanomas have developed metastasis after local treatment. Small tumours represent a significant risk of metastasis.
authors.affiliation: Croix-Rousse Hospital, University Eye Clinic, Lyon, France; University Claude Bernard Lyon 1, Lyon, France.
authors.forename: Ariane
authors.initials: A
authors.lastname: Malclès
authors.forename: Tero
authors.initials: T
authors.lastname: Kivelä
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Svetlosakova
authors.forename: Bruno
authors.initials: B
authors.lastname: Jean-Louis
authors.forename: Anh-Minh
authors.initials: AM
authors.lastname: Nguyen
authors.forename: Rébecca
authors.initials: R
authors.lastname: Sallit
authors.forename: Sylvie
authors.initials: S
authors.lastname: Négrier
authors.forename: Pascal
authors.initials: P
authors.lastname: Pommier
authors.forename: Michel
authors.initials: M
authors.lastname: Rivoire
authors.forename: Pierre
authors.initials: P
authors.lastname: Chauvel
authors.forename: Hamid
authors.initials: H
authors.lastname: Mammar
authors.forename: Mojgan
authors.initials: M
authors.lastname: Devouassoux-Shisheboran
authors.forename: Laurent
authors.initials: L
authors.lastname: Kodjikian
authors.forename: Philippe
authors.initials: P
authors.lastname: Denis
authors.forename: Jean-Daniel
authors.initials: JD
authors.lastname: Grange
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D001918:Brachytherapy; D002830:Choroid Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D061766:Proton Therapy; D012189:Retrospective Studies; D012429:Ruthenium Radioisotopes / Q000627:therapeutic use; D015996:Survival Rate; D014792:Visual Acuity
chemical_list: D012429:Ruthenium Radioisotopes
keywords: choroid; late metastases; melanoma; small tumour