RT Journal Article SR Electronic T1 Patients presenting with metastases: stage IV uveal melanoma, an international study JF British Journal of Ophthalmology JO Br J Ophthalmol FD BMJ Publishing Group Ltd. SP bjophthalmol-2020-317949 DO 10.1136/bjophthalmol-2020-317949 A1 Gaurav Garg A1 Paul T Finger A1 Tero T Kivelä A1 E Rand Simpson A1 Brenda L Gallie A1 Svetlana Saakyan A1 Anush G Amiryan A1 Vladimir Valskiy A1 Kimberly J Chin A1 Ekaterina Semenova A1 Stefan Seregard A1 Maria Filì A1 Matthew Wilson A1 Barrett Haik A1 Josep Maria Caminal A1 Jaume Catala-Mora A1 Cristina Gutiérrez A1 David E Pelayes A1 Anibal Martin Folgar A1 Martine Johanna Jager A1 Mehmet Doğrusöz A1 Gregorius P M Luyten A1 Arun D Singh A1 Shigenobu Suzuki A1 , YR 2021 UL http://bjo.bmj.com/content/early/2021/01/24/bjophthalmol-2020-317949.abstract AB Objective To analyse ocular and systemic findings of patients presenting with systemic metastasis.Methods and analysis It is an international, multicentre, internet-enabled, registry-based retrospective data analysis. Patients were diagnosed between 2001 and 2011. Data included: primary tumour dimensions, extrascleral extension, ciliary body involvement, American Joint Committee on Cancer (AJCC)-tumour, node, metastasis staging, characteristics of metastases.Results Of 3610 patients with uveal melanoma, 69 (1.9%; 95% CI 1.5 to 2.4) presented with clinical metastasis (stage IV). These melanomas originated in the iris, ciliary body and choroid in 4%, 16% and 80% of eyes, respectively. Using eighth edition AJCC, 8 (11%), 20 (29%), 24 (35%), and 17 (25%) belonged to AJCC T-categories T1–T4. Risk of synchronous metastases increased from 0.7% (T1) to 1.5% (T2), 2.6% (T3) and 7.9% (T4). Regional lymph node metastases (N1a) were detected in 9 (13%) patients of whom 6 (67%) had extrascleral extension. Stage of systemic metastases (known for 40 (59%) stage IV patients) revealed 14 (35%), 25 (63%) and 1 (2%) had small (M1a), medium-sized (M1b) and large-sized (M1c) metastases, respectively. Location of metastases in stage IV patients were liver (91%), lung (16%), bone (9%), brain (6%), subcutaneous tissue (4%) and others (5%). Multiple sites of metastases were noted in 24%. Compared with the 98.1% of patients who did not present with metastases, those with synchronous metastases had larger intraocular tumours, more frequent extrascleral extension, ciliary body involvement and thus a higher AJCC T-category.Conclusions Though higher AJCC T-stage was associated with risk for metastases at diagnosis, even small T1 tumours were stage IV at initial presentation. The liver was the most common site of metastases; however, frequent multiorgan involvement supports initial whole-body staging.