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We have read with great interest the article by Eskelin and Kivelä.1 This study provides information as to how uveal melanoma can be diagnosed and treated early if fundus examination is done by an ophthalmologist and also emphasises that routine indirect ophthalmoscopy should be done even in asymptomatic patients having an ophthalmic check up. We feel that indirect ophthalmoscopic evaluation of the dilated fundus is essential for identification of malignant uveal melanoma. This method of examination offers the best chance of detecting early retinal pathology and also allows follow up of progressive benign lesions suspected of potential malignancy.
In the Finnish population Eskelin and Kivelä have found 184 uveal melanoma cases in 5 years. Interestingly, in a study done by us on the Asian Indian population at the ocular oncology department of a tertiary eye care institute,2 we found only 71 cases of uveal melanoma in 12 years (0.02% incidence). The mean age of presentation in the Finnish population was found to be 60 years (range 14–87) and in the British 59.7 years.1 However, the mean age at presentation of uveal melanoma in the Asian Indian population was found to be 46.1 (range 13–75) years in the 71 cases studied by us. Similar low mean age of presentation (43.7 years) has been reported earlier in the Chinese population.3
In addition, there may be a difference between the Finnish and Asian Indian population in the mean basal diameter of the uveal melanoma at the time of presentation. In the Asian Indian population, the mean basal diameter of the tumour was 12.44 (SD 4.41) mm compared to 11.3 and 6.4 mm in the Finnish population and 11.6 mm and 4.9 mm in the British population. We feel that the Asian Indians present at an earlier age with large tumours in comparison with the Western population. This comparison re-emphasises the racial differences in presentation of uveal melanoma. Whether this has any bearing on the prognosis and the implication of early onset melanoma in pigmented populations remains to be seen.