Observation

Patients with iris melanomas have relatively good outcomes, with 5-year survival rates exceeding 95%. Iris melanomas are predominantly of the spindle-cell type and are usually smaller in size than posterior melanomas because they are detected earlier. Conservative management is generally advocated whenever possible, but surgical intervention may be justified with unequivocal tumor growth or with extensive disease at initial examination.

The management of small choroidal melanomas is controversial, and it is not clear whether treating small tumors prevents metastasis.[1] The natural history of small choroidal melanomas is poorly understood. Small, pigmented, choroidal lesions cannot always be differentiated reliably on examination. Growth is a presumed indicator of malignant potential.[2] The likelihood of progression from the time of diagnosis to the time when tumor growth warrants treatment has not been well characterized. Some ophthalmologists advocate observation. This course has been justified on several grounds, including the difficulty of establishing a correct diagnosis, the lack of any documented efficacy for globe-conserving treatments, and concerns for severe treatment-related morbidity. Others have advocated earlier therapeutic intervention.[1,3,4]

Although patients diagnosed with small choroidal tumors were not eligible for participation in the Collaborative Ocular Melanoma Study (COMS), these patients could participate in a prospective follow-up study to evaluate the natural history of small lesions. The 2-year tumor growth estimates were 21%, and the 5-year tumor growth estimates were 31%.[5] Clinical risk factors associated with tumor growth included:[3,5]