Elsevier

Ophthalmology

Volume 119, Issue 8, August 2012, Pages 1582-1589
Ophthalmology

Original article
Detection and Time to Treatment of Uveal Melanoma in the United Kingdom: An Evaluation of 2384 Patients

https://doi.org/10.1016/j.ophtha.2012.01.048Get rights and content

Purpose

To determine the mode of detection of uveal melanoma and time to treatment in the United Kingdom.

Participants

A total of 2384 patients diagnosed with uveal melanoma at the Liverpool Ocular Oncology Center between 1996 and early 2011.

Methods

A questionnaire was completed with every new patient, and the results were correlated with clinical features and treatment.

Main Outcome Measures

Tumor detection, practitioner initiating referral, referral pathway, time to treatment, baseline clinical features, and primary ocular treatment.

Results

The referral process was initiated by an optometrist, family doctor, or ophthalmologist in 68.0%, 18.2%, and 13.8% of patients, respectively. On referral, 30.2% of patients were asymptomatic. Twenty-three percent of patients reported that their tumor was initially missed; these tended to have a more advanced tumor when they reached our center. The time from referral to treatment had a median of 49 days, exceeding 6 months in 19.8% of patients. This delay was longer in patients who reported that their tumor was missed (median, 92 vs. 40 days; Mann–Whitney, P<0.001). Ophthalmologists delayed the referral process by more than 6 months in 10.9% of patients. Primary enucleation was performed in 33.3% of patients and was more likely in those who reported that their tumor was missed (44.8% vs. 29.8%; chi-square, P<0.001).

Conclusions

Many patients with uveal melanoma experience long delays in treatment because their tumor was missed or misdiagnosed. Such patients tend to have a more advanced tumor by the time they reach an oncology center and are more likely to require enucleation.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Inclusion Criteria

Patients were included in this study if (1) they were diagnosed with uveal melanoma at the Liverpool Ocular Oncology Center between 1997 and 2011; (2) their referral was initiated by a family doctor, optometrist, or ophthalmologist; and (3) they resided in the United Kingdom. There were approximately 21 patients (0.1%) whose referral was initiated by other practitioners, such as radiologists, nurses, and gynecologists. These outliers were excluded to enhance the clarity and brevity of this

Patient Demographics

A review of our database showed that 2384 patients were referred to our unit between April 1997 and March 2011 (Table 1, available at http://aaojournal.org). The patients (1175 female, 1209 male) had a median age of 62.1 years when their tumor was detected or the referral process was initiated. The first practitioner in this care pathway was an optometrist in 1621 patients (68.0%), a family doctor in 435 patients (18.2%), and an ophthalmologist in 328 patients (13.8%) (Fig 1). Before 2001, the

Main Findings

The time from initiation of the referral process to the date of primary ocular treatment exceeded 6 months in 19.8% of patients. This delay was considerably longer in patients who reported that their tumor had been missed (median, 92 vs. 40 days). Such patients accounted for 23.1% of our cohort. Patients initially seen by an optometrist waited longer to see an ophthalmologist if they were referred via a family doctor instead of directly (median, 44 vs. 10 days). Conversely, patients whose

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Manuscript no. 2011-1606.

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

The Liverpool Ocular Oncology Center is funded by the National Specialist Commissioning Team of the National Health Service of England, which had no role in the design or conduct of this study.

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