Local resection and other conservative therapies for intraocular melanoma

Mortality after enucleation for intraocular melanoma is 50% in 10 to 15 years. Death rates after conservative management by local resection, proton beam irradiation, or plaque radiotherapy appear to be similar to post-enucleation mortality in retrospective studies. Risk factors for metastatic death include tumor size, location, cell type, and age of patient and are common to all forms of management including enucleation. The eye and vision can be retained in most cases treated conservatively but choice of conservative management is dependent on patient and tumor characteristics. Any adverse effect on survival posed by conservative management is likely to be slight. Randomized prospective trials that would be needed to establish whether this is true in the case of local resection or proton beam irradiation would be difficult to mount and are unlikely to be conducted.