How Should We Manage a Patient With Uveal Melanoma?

For approximately 100 years, enucleation has been the standard treatment for uveal melanoma.1It has been assumed that removing the cancer soon after diagnosis would prolong the patient's life. In the 1960s, the urgency to enucleate was suppressed somewhat by a report that up to 20% of eyes removed for suspected melanoma did not harbor a melanoma.2In the 1970s, when Zimmerman et al3and Zimmerman and McLean4proposed that enucleation increased mortality by promoting micrometastases during surgery, the desirability of prompt enucleation was seriously questioned. About this same time, several investigators began to experiment with so-called conservative forms of treatment that allowed the patient with a melanoma to retain the affected eye. While conservative management includes radiation, photocoagulation, and eye wall resection, among others, radiation therapy has been evaluated most extensively. See also pp 916 and 924. The two types of radiation treatment arebrachytherapy