@article {Garg510, author = {Gaurav Garg and Paul T Finger and Tero T Kivel{\"a} and E Rand Simpson and Brenda L Gallie and Svetlana Saakyan and Anush G Amiryan and Vladimir Valskiy and Kimberly J Chin and Ekaterina Semenova and Stefan Seregard and Maria Fil{\`\i} and Matthew Wilson and Barrett Haik and Josep Maria Caminal and Jaume Catala-Mora and Cristina Guti{\'e}rrez and David E Pelayes and Anibal Martin Folgar and Martine Johanna Jager and Mehmet Do{\u g}rus{\"o}z and Gregorius P M Luyten and Arun D Singh and Shigenobu Suzuki}, editor = {, and , and Finger, Paul T and Coupland, Sarah E and Albert, Daniel M and Amiryan, Anush G and Saakyan, Svetlana and Auw-H{\"a}drich, Claudia and Baker, Diane and Barnhill, Raymond and Caminal, Jos{\'e} M and Caroll, William L and Cassoux, Nathalie and Desjardins, Laurence G and Pierron, Gaelle and Catal{\'a}-Mora, Jaume and Chantada, Guillermo and Ch{\'e}vez-Barrios, Patricia and Max Conway, R and Damato, Bertil E and Demirci, Hakan and Dutton, Jonathan J and Esmaeli, Bita and Prieto, Victor G and Williams, Michelle and Gallie, Brenda L and Graue, Gerardo F and Grossniklaus, Hans E and Heegaard, Steffen and Holbach, Leonard M and Honavar, Santosh G and Jager, Martine J and Kivel{\"a}, Tero T and Kujala, Emma and Rouic, Livia Lumbroso-Le and Mallipatna, Ashwin C and Modorati, Giulio M and Munier, Francis L and Murray, Timothy G and Pavlick, Anna C and Pe{\textquoteright}er, Jacob and Pelayes, David E and Rodrigues, Manuel and Sauerwein, Wolfgang A G and Semenova, Ekaterina and Seregard, Stefan and Shields, Carol and Rand Simpson, E and Singh, Arun D and Suzuki, Shigenobu and Washington, Mary Kay and White, Valerie A and Wilson, Mathew W and Wittekind, Christian W and Yin, Vivian}, title = {Patients presenting with metastases: stage IV uveal melanoma, an international study}, volume = {106}, number = {4}, pages = {510--517}, year = {2022}, doi = {10.1136/bjophthalmol-2020-317949}, publisher = {BMJ Publishing Group Ltd}, abstract = {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{\textendash}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.Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information. Data are available upon reasonable request.}, issn = {0007-1161}, URL = {https://bjo.bmj.com/content/106/4/510}, eprint = {https://bjo.bmj.com/content/106/4/510.full.pdf}, journal = {British Journal of Ophthalmology} }