The observed and relative survival of patients diagnosed with a melanoma in the ocular region and choroid/ciliary body in Denmark during the period 1943-97 and followed through 2002 has remained stable. The highest observed and relative survival was found for iris melanomas, the lowest for choroid/ciliary body melanomas, and intermediate for conjunctival melanomas.

The incidence of malignant melanoma in the ocular region was stable in contrast to a major increase in cutaneous melanoma in Denmark during the period 1943-97. The incidence of iris melanomas increased substantially, whereas the rate was stable for choroid/ciliary body and conjunctival melanomas.

Optic nerve invasion in uveal melanoma is found in 1 in 20 patients. Visible juxtapapillary melanoma or loss of light perception should make the clinician suspicious of melanoma with optic nerve invasion, and special awareness of postlaminar spread should be addressed when increased IOP is present independently of decreased visual acuity and tumor location.

ABSTRACT.Purpose: To evaluate prognostic factors for the survival of patients treated by enucleation for choroidal and ciliary body melanomas. Methods: The study included 293 consecutive patients (147 men and 146 women) treated by enucleation for a choroidal or ciliary body melanoma during the period 1955-2000. The median age at treatment was 61 years (range 26-88 years). Clinical and histopathological findings, vital status at October 1st, 2002, and cause of death were registered. Prognostic factors for survival were evaluated by univariate and multivariate Cox proportional hazards analysis and by Kaplan-Meier survival analysis. Results: Follow-up was complete. The median follow-up time was 6.2 years (range 21 days to 43.4 years) and the median potential follow-up time was 25.7 years (range 1.9-47.7 years). In multivariate Cox proportional hazards analysis an increased risk of melanoma-related death was found for largest basal diameter (n ¼ 264, p < 0.001, mortality rate ratio (RR) ¼ 1.09 for continuous parameter in mm), anterior tumour margin at the iris/ciliary body versus choroid (p < 0.001, RR ¼ 2.22), and non-spindle cell type versus spindle cell (p ¼ 0.047, RR ¼ 1.45). An increased risk of death from all causes was found for men versus women (n ¼ 266, p ¼ 0.02, RR ¼ 1.41), high age (p < 0.001, RR ¼ 1.41 for continuous parameter in 10-year age groups), largest basal diameter (p < 0.001, RR ¼ 1.07), anterior tumour margin at the iris/ciliary body (p ¼ 0.02, RR ¼ 1.52), and non-spindle cell type (p ¼ 0.04, RR ¼ 1.34). Conclusion: The risk of melanoma-related death after enucleation for a choroidal or ciliary body melanoma was high for tumours with large basal diameter, of non-spindle cell type and anterior location. Additional risk factors for death from all causes were male sex and high age.