PURPOSE To characterize the clinical spectrum of class 1 and class 2 uveal melanomas and their relationship with intraocular proton radiation response. DESIGN Masked retrospective case series of uveal melanoma patients with fine needle biopsy– based molecular profiles. METHODS A total of 197 uveal melanoma patients from a single institution were analyzed for pathology, clinical characteristics, and response to radiation therapy. RESULTS A total of 126 patients (64%) had class 1 tumors and 71 (36%) had class 2 tumors. Patients with class 2 tumors had more advanced age (mean: 64 years vs 57 years; P = .001), had thicker initial mean ultrasound measurements (7.4 mm vs 5.9 mm; P = .0007), and were more likely to have epithelioid or mixed cells on cytopathology (66% vs 38%; P = .0004). Although mean pretreatment and posttreatment ultrasound thicknesses were significantly different between class 1 and class 2 tumors, there was no difference in the mean change in thickness 24 months after radiation therapy (mean difference: class 1=−1.64 mm, class 2=−1.47; P = .47) or in the overall rate of thickness change (slope: P = .64). Class 2 tumors were more likely to metastasize and cause death than class 1 tumors (DSS: P < .0001). CONCLUSIONS At the time of radiation therapy, thicker tumors, epithelioid pathology, and older patient age are significantly related to class 2 tumors, and class 2 tumors result in higher tumor-related mortality. We found no definitive clinical marker for differentiating class 1 and class 2 tumors.

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\s=b\A retrospective search of the Duke University Melanoma Clinic patients identified 399 cases with primary malignant melanoma located in the head and neck region. Ninety-five percent of the deaths in this series were from metastatic melanoma. Various clinical and pathological data were examined and their effects on survivability and disease-free intervals were evaluated. The characteristics noted included sex, age, depth of the invasion, thickness, site of the lesion, histologic type, and nodal status. A multivariate regression analysis identified the following factors as having a negative effect on survival: nodular histologic type, scalp primary, increasing Clark level, and male sex. In comparing head and neck, extremity, and truncal primary sites, the median survival for patients with head and neck malignant melanomas was notably less. These differences correlated with a higher incidence for male patients, for patients with thicker lesions, and for patients with an increased frequency of nodular histologic type. (Arch Otolaryngol 1983;109:803-808) Management of malignant mela¬ noma has plagued physicians for centuries. Robert Carswell, MD,1 in 1834, is credited with the first clinical description of a malignant mel¬ anoma, while Pemberton,2 in 1855, reported one of the first cases of mela¬ noma of the head and neck. He de¬ scribed a 53-year-old manwhowasseen with a "black patch of disease on the right cheek."2 This patient soon died of diffuse metastatic disease. Primary melanoma of the head and neck ac¬ counts for 25% to 30% of all melano¬ mas. The head and neck region is highly visible to both the patient and the phy¬ sician, suggesting that early diagnosis of melanoma in this location should be possible. The skin of the head and neck, however, is unique for several reasons. It has a much higher density of melano¬ cytes than comparable areas on the trunk or extremities.3 The extent to which it is exposed to sunlight and its rich investment of both lymphatic drainage and vascular supply, causes ham, NC 27710 (Dr Fisher). the head and neck region to be more susceptible to the development of pri¬ mary melanoma and to show a higher propensity for both local and distant metastatic spread. Reported five-year survival rates for persons with head and neck mela¬ noma range from 8% to 60%.47 Most of these series involve a small number of patients collected over a long period during which the treatment regimens were not always comparable. This makes statistical evaluation and com¬ parison with other studies difficult. In this article, we describe our experi¬ ence with 399 patients with cutaneous head and neck melanoma treated dur¬ ing a ten-year period during which standardized treatment and adjuvant therapy protocals were performed. MATERIALS AND METHODS Patient Population General Characteristics.-The Duke University Melanoma Clinic in Durham, NC, has registered more than 2,500 patients with melanoma during the last ten years. During a retrospective, comput¬ er-aided data search, 399 cases of head and neck mela...

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