Photo Credit: Todorean

Over 5 years of surveillance, just 4% of patients with low-risk uveal melanoma developed metastasis, according to a retrospective cohort study published online ahead of print in Ophthalmology.

The single-institution analysis considered the effectiveness of surveillance protocols for patients with uveal melanoma at low risk for metastasis.

“Surveillance protocols provide patients with reassurance. However, the risk-versus-benefit ratio of screening in low metastatic risk patients must be carefully weighed against potential harm from false positive findings, induced anxiety, and healthcare costs,” researchers wrote.

The study included 144 consecutive patients with class 1 primary uveal melanoma. Patients were advised to follow a standard surveillance protocol of hepatic ultrasonography every 6 months or an enhanced protocol with a high-frequency (ultrasonography every 3 months) or enhanced modality (hepatic CT/MRI). Patients chose their surveillance protocol after discussion with their medical oncology and ocular oncology team.

Relevance of 6-Month Standardized Screening Protocol

Most patients (70%) chose the standard surveillance protocol, with the remaining 30% opting for the enhanced protocol, according to the study.

Over a median follow-up period of 50.6 months, a total of 834 ultrasound scans were performed. Metastasis was detected, and confirmed via biopsy, in six patients. Among them, five patients had received the standard surveillance protocol, and one patient had received enhanced surveillance. The median largest diameter of largest hepatic metastasis was 2.8 cm at detection.

When researchers examined metastasis risk factors, largest diameter of largest hepatic metastasis alone was significantly associated with increased hazard (hazard ratio, 1.33). Age, tumor thickness, and PRAME (preferentially expressed antigen in melanoma) status showed no significant links with increased metastasis risk.

All six patients with metastasis received treatment: one received liver-directed therapy and five received systemic therapy.

Based on the study’s findings, standardized 6-month protocols for all patients with class 1 primary uveal melanoma may be excessive, researchers observed.

“Most patients with [uveal melanoma] predicted to have low risk of metastasis do not develop metastasis within 5 years (96%). Surveillance protocols in such patients have very low yield (<1%) and their impact on survival cannot be assessed,” the authors wrote. “Our study demonstrates the need for further risk refinement of low-risk UM patients to better identify at-risk individuals. Currently used surveillance protocols need to be optimized.”