Metastatic Uveal Melanoma Therapy

Abstract

Uveal melanoma is the most common primary intraocular malignant tumor in adults and the second most common type of primary malignant melanoma in the body. It represents 5% to 6% of all melanoma diagnoses. Metastasis is by vascular spread, and approximately 40% to 50% of patients with primary uveal melanoma will ultimately develop metastases. At the time of diagnosis, over 99% of patients have disease limited to the eye, but at least 30% of these patients will die of systemic metastases at 5 years and 45% at 15 years. 1 Of the patients who die of uveal melanoma, 62% and 90% do so within 5 and 15 years, respectively. The liver is involved in up to 95% of individuals who develop metastatic disease. 2,3 The survival of patients with metastatic uveal melanoma is directly related to the presence of liver metastasis. Liver is the first site of systemic metastasis for most patients and the exclusive site of systemic metastasis in approximately 40% of the patients. The clinical course of patients with uveal melanoma is determined by progression of the disease in the liver. Despite therapy, the median survival of patients who develop liver metastases is reported to be about 6 months, and the 1-year survival is estimated to be 10% to 15%. 4 In contrast, patients with metastatic melanoma confined to extrahepatic sites have a median survival of approximately 19 to 28 months with 76% of the patients surviving over a year. 1,5,6 n Prognosis and Treatment of Disseminated Uveal MelanomaDespite advances in diagnosis and management of the primary uveal melanoma, systemic uveal melanoma metastases are difficult to treat. 6 The management of metastatic uveal melanoma is dependent on whether metastatic disease is confined to the liver. Regional therapies such as surgical resection, isolated hepatic perfusion, intraarterial hepatic

Immune Expression and Inhibition of Heat Shock Protein 90 in Uveal Melanoma

“…Metastatic disease disseminates predominantly to the liver in 71.4% to 87% of the patients and chemotherapy is minimally effective (2).…”

Uveal Melanoma: A Review of the Literature

“…About 50% of these patients with liver metastasis have extrahepatic involvement. The most common extrahepatic metastasis sites are the lungs (30%), bone (23%), and skin (17%) [22].…”

“…Although these findings are suggestive of a survival benefit from surgery, it must be noted that surgical resection is found to be feasible in less than 10% of uveal melanomas metastatic to the liver. Limiting factors include too many metastatic foci, tumors in difficult locations, insufficient hepatic reserve, and tumors invading blood vessels [22].…”

The First Case of Omental Metastasis from Primary Choroidal Melanoma

“…Intraocular melanoma, the second most common form of melanoma (11), differs from cutaneous melanoma in many respects. Although it was reported that BRAF and NRAS mutations were found in 66 and 20% of cutaneous melanomas, respectively (12), most studies failed to identify these mutations in intraocular melanoma tissues (13 -16).…”