Mary E. Aronow

<b><i>Purpose:</i></b> To analyze trends in incidence, treatment, and survival of uveal melanoma in the United States from 1973 to 2013 using the Surveillance, Epidemiology, and End Results database. <b><i>Materials and Methods:</i></b> Patients were identified using International Classification of Disease for Oncology codes: C69.3 (choroid), C69.4 (ciliary body and iris), and C69.2 (retina). Trends in age-adjusted incidence, treatment (surgery or radiation), and 5-year relative survival were calculated. <b><i>Results:</i></b> There were 4,999 cases of uveal melanoma. The majority (97.8%) were reported by hospital inpatient/outpatient clinics. Histopathologic confirmation was available in 67.8%. The mean age-adjusted incidence was 5.2 per million (95% CI 5.0-5.4). When the incidence was standardized for race, a small but statistically significant (<i>p</i> < 0.05) annual percentage change of 0.5% was detected in Whites. There was a decline in patients treated with surgery alone (94.2% from 1973 to 1975 vs. 24.7% from 2012 to 2013). A corresponding increase was observed in radiation as primary treatment selection (1.3% from 1973 to 1975 vs. 68.3% from 2012 to 2013). No change in the 5-year relative survival (80.9%) was observed. <b><i>Conclusions:</i></b> The age-adjusted incidence of uveal melanoma has remained stable with a minor increase in Whites. Despite a shift towards globe-preserving treatment, there has not been a concomitant improvement in survival.

Two hundred sixty-two patients with 50% or greater obstruction of at least one coronary artery on the initial study underwent recatheterization 2-182 months later and were evaluated for progressive arterial changes. Progression was considered present if (1) a change from less than total obstruction to total obstruction occurred in any vessel; (2) a change from 70% or less to 90% or more occurred in any vessel; (3) a change from 30% or less to 50% or more occurred in any vessel not initially obstructed by 50%; or (4) a 20% or more increase in obstruction was noted in any vessel already narrowed 50% or more. Of the 262 patients, 116 of 238 men (49%) and 12 of 24 women (50%) met the criteria for progression. Risk factors determined at the time of the initial catheterization in patients who met the criteria for progression were compared with risk factors in patients who did not. No significant difference could be found between the groups in relation to family history, blood pressure, diabetes, smoking habits, weight, cholesterol levels, triglyceride values, initial ECG and initial catheterization findings. The frequency of detecting progressive arterial changes tended to increase as the interval between studies increased (p less than 0.001). The frequency of multiple vessel progression increased as the interval between studies increased. Progression was more frequent in patients younger than 50 years than it was in patients 50 years and older.

PURPOSE: To report outcomes and complications of fine-needle aspiration biopsy (FNAB) of uveal melanoma performed for diagnostic and prognostic purposes. METHODS: Prospective interventional case series of 150 consecutive patients with a clinical diagnosis of uveal melanoma. The FNAB approach (transcorneal (TCO), transscleral (TSC) and transvitreal (TVT) was primarily determined by the location of the tumour. The FNAB was performed using a 25-gauge needle using a previously published technique. Prognostication was done using fluorescent in situ hybridisation detection of monosomy of chromosome 3. RESULTS: FNAB was obtained via TCO (8), TSC (71) and TVT (64) approach and impression smear in seven cases. Diagnostic yield was 92%. False-negative results were observed in 8%. Diagnostic yield was significantly correlated to biopsy approach (TCO 100%, TSC 96%, TSV 86%; p=0.029) and tumour size (basal diameter >5.0 mm; height >2.5 mm). Persistent haemorrhage (subretinal haemorrhage or vitreous) requiring surgical intervention (1%) and rhegmatogenous retinal detachment (1%) were rare. Endophthalmitis, hypotony, tumour recurrence, episcleral seeding were not observed over the average follow-up of 37 months. Prognostication could be performed in 85% of cases. Overall, only 47% of eligible patients enrolled into the adjuvant therapy trial. CONCLUSIONS: FNAB for uveal melanoma with 25-gauge needle is a safe procedure that can yield diagnostic and prognostic information in vast majority of cases (92% and 85%, respectively). Even so, only about half of the eligible cases eventually enrolled into the adjuvant therapy trial. Possibility of negative FNAB yield should be considered when counselling patients with small tumours. Alternative means of diagnostic biopsy and methods of prognostication need to be assessed for small tumours.