Elsevier

Ophthalmology

Volume 118, Issue 9, September 2011, Pages 1881-1885
Ophthalmology

Original article
Uveal Melanoma: Trends in Incidence, Treatment, and Survival

https://doi.org/10.1016/j.ophtha.2011.01.040Get rights and content

Purpose

To determine trends in incidence, treatment, and survival with primary uveal melanoma in the United States over a 36-year period from 1973 to 2008.

Design

Systematic review of existing databases.

Participants

A total of 4070 patients with primary uveal melanoma (International Classification of Disease for Oncology [ICD-O-2] codes C69.3 [choroid], C69.4 [ciliary body and iris], and C69.2 [retina]) derived from the Surveillance, Epidemiology, and End Results (SEER) program database in the United States from 1973 to 2008.

Methods

The significance of trends in age-adjusted incidence, treatment, and 5-year relative survival rates were determined using chi-square testing and 95% confidence intervals (CIs).

Main Outcome Measures

Age-adjusted incidence, form of treatment (surgery, radiation, or both), and 5-year relative survival rates.

Results

There were 4070 cases of uveal melanoma representing 3.1% of all recorded cases of melanoma. The majority of cases (98.3%) were reported by hospital inpatient/outpatient clinics. Histopathologic confirmation was available in 2804 cases (72.1% for all years). The mean age-adjusted incidence of uveal melanoma in the United States was 5.1 per million (95% CI, 4.8–5.3). The majority of cases (97.8%) occurred in the white population. There was a statistically significant variation of age-adjusted incidence between sexes (male = 5.8, 95% CI, 5.5–6.2; and female = 4.4, 95% CI, 4.2–4.7). A decreasing trend was observed in patients treated with surgery alone (93.8% for 1973–1975 vs. 28.3% for 2006–2008), whereas a corresponding increase was seen in those treated with radiation (1.8% for 1973–1975 vs. 62.5% for 2006–2008). No change in the 5-year relative survival rate (81.6%) was observed from 1973 to 2008.

Conclusions

The age-adjusted incidence of uveal melanoma (5.1 per million) has remained unchanged from 1973 to 2008. Despite a shift toward more conservative treatments, survival has not improved during this time period.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Materials and Methods

The National Cancer Institute SEER Public Use CD-ROM was used to calculate the age-adjusted incidence, trends in treatment, and 5-year relative survival of uveal melanoma from 1973 to 2008.11 Calculation of incidence rates involved a 2-step process. First, age-specific rates were calculated using census estimates for the population and the 36-year period of time studied (thus adjusting for population increases). Second, these age-specific rates were age-adjusted to a “standard” population and

Results

There were 131 723 cases of melanoma reported in the SEER database over the 36-year period between 1973 and 2008. Of all melanoma cases, 3.8% were considered to be ocular/adnexal melanoma. Of these, a total of 4070 cases (81.4%) were classified as uveal melanoma (i.e., site coded as retina, choroid, ciliary body, or iris) comprising 3.1% of all melanoma cases. A total of 8.5% were from a nonspecified site, and the remaining 10.1% were from sites including conjunctiva, cornea, orbit, or other

Discussion

In the current study, the average age-adjusted incidence of uveal melanoma remained stable with 5.1 cases per million population over the 36-year study period. An increasing proportion of patients were treated by radiation alone, and a corresponding decrease was observed in the number of tumors treated with surgery or enucleation. Despite changing trends in treatment, the 5-year relative survival rate (∼81.6%) remained unchanged.

The present analysis uses the SEER program database, which is

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    Manuscript no. 2010-1480.

    Supported by a Falk Trust grant and a Research to Prevent Blindness Challenge Grant, Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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