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The Zimmerman-McLean-Foster hypothesis: 25 years later
  1. A D Singh1,
  2. I G Rennie2,
  3. T Kivela3,
  4. S Seregard4,
  5. H Grossniklaus5
  1. 1Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
  2. 2Department of Ophthalmology and Orthoptics, University of Sheffield, UK
  3. 3Ocular Oncology Service and Ophthalmic Pathology Laboratory, Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland
  4. 4St Erik’s Eye Hospital and Karolinska Institute, Stockholm, Sweden
  5. 5Department of Ophthalmology, Emory University, Atlanta, GA, USA
  1. Correspondence to: A D Singh MD Director, Department of Ophthalmic Oncology, Cole Eye Institute (i3-129), Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA;


It is now 25 years since the publication of the landmark article by Zimmerman, McLean, and Foster, in which they cast doubts on the benefit of enucleation, which was the prevailing management of choroidal melanoma at that time. Over the past 25 years several advances have been made in the management of uveal melanoma. Research in the pathobiology of cancer metastasis in general and uveal melanoma in particular has also provided new insights. In this review, the Zimmerman-McLean-Foster hypothesis is explored in the light of current clinical, epidemiological, statistical, and experimental evidence.

  • Zimmerman-McLean-Foster hypothesis
  • uveal melanoma
  • tumour resction

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  • Supported in part by NIHR01 EY13165.

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