Failure to detect or correctly diagnose uveal melanoma may delay treatment and increase the need for enucleation, according to a large study.
“Our impressions are that ophthalmologists need to improve their ability to identify orange pigment and serous retinal detachment and to consider these features as indications for immediate referral to an oncology center,” the study authors said. “More widespread availability of autofluorescence photography and optical coherence tomography should alleviate this problem.”
The prospective cohort analysis included 2,384 patients with a mean age of 62.1 years who were diagnosed with uveal melanoma between 1996 and 2011.
Treatment consisted of radiotherapy, surgical excision or phototherapy. Mode of treatment was based on tumor size, location and area, while taking into consideration patient needs and desires.
After treatment, patients were followed after 1 to 4 weeks, every 6 months for 3 to 5 years, and then once annually.
An optometrist initiated referral in 68% of cases, a family doctor in 18.2% of cases and an ophthalmologist in 13.8% of cases; 30.2% of patients were asymptomatic at referral.
Tumors were initially missed in 23% of patients; these patients typically had more advanced tumors when they were treated.
The study found that 33.3% of patients underwent primary enucleation. The rate of primary enucleation was 44.8% among patients who reported that their tumors were missed and 29.8% among patients who reported that their tumors were detected; the between-group difference was statistically significant (P < .001).
The authors said that 20.2% of patients initially referred by a family doctor and 11.6% of those referred by an optometrist or ophthalmologist were likely to have visual acuity worse than 20/200.