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Presumed incipient choroidal melanoma: proposed diagnostic criteria and management
  1. Susanna Jouhi,
  2. Ranaa T Al-Jamal,
  3. Martin Täll,
  4. Sebastian Eskelin,
  5. Tero T Kivelä
  1. Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  1. Correspondence to Susanna Jouhi, Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland; susanna.jouhi{at}helsinki.fi

Abstract

Aims To propose diagnostic criteria for a presumed incipient choroidal melanoma based on tumour growth rate and tumour doubling time (TDT) and to describe management of such tumours with transpupillary thermotherapy (TTT).

Methods Retrospective interventional case series of nine consecutive presumed incipient uveal melanomas diagnosed and treated with TTT in 2010–2017. Growth rate in mm/year and per cent/year in largest basal diameter (LBD) and TDT were compared with published data for uveal melanomas and growing naevi that did not transform to melanoma under long-term follow-up.

Results The median LBD and thickness were 1.6 mm (range 0.9–2.3) and 0.20 mm (range 0.15–0.29), respectively. The median age was 57 years (range 47–78). Seven tumours were classified as de novo melanomas and two as transformed naevi. The median time from first observation to diagnosis was 3.3 years (range 2.2–7.3), LBD growth rate 0.25 mm/year (range 0.11–0.72) and 34 per cent/year (range 10–1437), and TDT 609 days (range 97–1612). The estimates matched those reported for uveal melanoma (median TDT 521 days, 90th percentile 2192) and exceeded those for growing naevi (median growth rate 0.04 mm/year, 90th percentile 0.12; 1.1 per cent/year, 90th percentile 2.6). The predicted median age at de novo appearance was 51 years (range 32–63). No tumour grew after TTT during a median follow-up of 2.1 years (range 0.6–8.7).

Conclusions In this series, relative growth rate and TDT best qualified as diagnostic criteria for an incipient choroidal melanoma. Too small for brachytherapy, they could be managed with TTT.

  • choroid
  • treatment lasers

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Contributors SJ and RAJ conducted the work and TK was the supervisor. All authors, SJ, RAJ, MT, SE and TK contributed to the planning and reporting of the work, the design and implementation of the research, the analysis of the results and the writing of the manuscript.

  • Funding The authors received grants from the following not-for-profit institutions: The Helsinki University Hospital Research Fund (TYH2017218 and TYH2020315), the Sigrid Jusélius Foundation, Helsinki, Finland, the Eye Foundation, Helsinki, Finland, the Mary and Georg C. Ehrnrooth Foundation, Helsinki, Finland, and the Finnish Ophthalmological Society, Helsinki, Finland. Grant numbers other than The Helsinki University Hospital Research Fund were not provided by the funding organisations.

  • Disclaimer The funding organisations had no role in the design or conduct of this research.

  • Competing interests TK received lecture fees from Santen Finland, unrelated to this work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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