The melanoma controversy. A comparison of choroidal, cutaneous, and iris melanomas

Controversy exists regarding the management of patients with choroidal melanomas. Some experts argue that these neoplasms behave differently than other types of melanomas, and that enucleation rather than tumor burden is responsible for metastases. A review of the literature involving death rates of patients diagnosed with melanomas of the choroid, skin and iris demonstrates the importance of tumor volume as a prognostic indicator. In each instance, the smaller the tumor burden, the better the prognosis. Death rates from metastases involving small choroidal tumors (less than 300 mm) were surprisingly similar to to those from cutaneous melanomas of the same size. Large tumors of the choroid carried a much higher death rate, as did large tumors of the skin. While studies involving iris melanomas reported only a 2.6% death rate, the average volume of an iris melanoma is only 55 mm. We believe that biologically all melanomas have the same potential for metastatic growth and that the size of the tumor may be the most important variable with regard to prognosis.