Original articleManagement of Posterior Uveal Melanoma: Past, Present, and Future: The 2014 Charles L. Schepens Lecture
Section snippets
The Past
In the early part of the 20th century, there was little published information on the treatment of PUM. At that time, patients often presented to their physician with tumor filling the globe, frequently causing inflammation, secondary glaucoma, pain, or proptosis due to orbital extension of the tumor. Such cases displayed high mortality secondary to metastasis to liver and other sites.1
In a review of his experience with 22 cases of uveal melanoma and 239 cases from other clinicians, Fuchs,2 in
The Present
All of the aforementioned developments have provided groundwork information for the current management of PUM. In the selection of treatment, one must take into account information collected from the numerous clinical reports on treatment, including the COMS and the AJCC classification results.
The management selected for PUM depends on several factors, including tumor size and extent, patient age, general health, status of the opposite eye, and other factors, including patient personal desires
The Future
The management of PUM is gradually transforming from focal ophthalmic therapy to combination ophthalmic and systemic therapies, based on detection of cytogenetic and molecular pathway events that lead to the development of melanoma and metastatic disease. We have gained tremendous knowledge in our understanding of tumors at risk for metastasis and basic tumor development, but there is more to discover. Improved patient prognosis will rely on earliest detection, better local treatments with
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Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Support provided by the Schepens Award of the Retina Research Foundation, Houston, Texas (JAS), the Eye Tumor Research Foundation, Philadelphia, Pennsylvania (J.A.S., C.L.S.), the Paul Kayser International Award of Merit in Retina Research, Houston, Texas (J.A.S.), Lift for a Cure, Morrisdale, Pennsylvania (J.A.S., C.L.S.), and the Lucille Wiedman Fund for Pediatric Eye Cancer, Philadelphia, Pennsylvania (J.A.S., C.L.S.). The funders had no role in the design and conduct of the study; the collection, analysis, and interpretation of the data; or the preparation, review, or approval of the manuscript. J.A.S. has had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.