National Eye Institute-Melanoma Conference

TY - JOUR

T1 - National Eye Institute-Melanoma Conference

AU - Albert, Daniel M.

N1 - Funding Information: The question of whether the traditional management of melanomas of medium to large size should be modified and, if so, how, was discussed. Frederick T. Fraun-felder reviewed his "no touch" technique of enucleation to prevent tumor spread from occurring secondary to ocular manipulation during enucleation. This technique avoids intraocular pressure increase above 15 mm/Hg before freezing completely around the tumor, thereby preventing flow of fluid and blood to or from the tumor before the manipulation necessary for enucleation. Francis LaPi-ana reviewed an alternative method of surgery aimed at minimizing the dissemination of tumor cells utilizing a pressure stabilizing device. The use of adjunctive therapy, including radiation, chemotherapy, and immunotherapy, was discussed by Marvin Rotman, David Berd, Devron Char, and others. Overall, there was little enthusiasm for replacement of enucleation for tumors of medium to large size by other therapeutic modalities. With regard to poor prognosis cases (those cases in which the expected tumor death rate exceeds 50% as determined after pathologic study of size, cell type, mitotic activity, extraocular extension, vascular invasion, and the like), the role of adjunctive therapy, particularly preoperative or postoperative radiation, or both, was raised. While having the enthusiastic endorsement of radiotherapists such as Dr. Rotman, there appears little hard data to evaluate the usefulness of these modalities. This lack of such information seems to make difficult the establishment of randomized clinical trials at the present time for the purpose of evaluating adjunctive therapy in poor prognosis cases. Victor Curtin, Jerry Shields, and Frederick Davidorff presented their ongoing evaluation of series of patients with small melanomas, defined as those 10 mm or less in their largest diameter and 2 mm or less in elevation. William R. Green re- viewed the results of cases on file in the Wilmer Pathology collection, including 70 cases that have been followed up for over five years. These studies appeared to confirm the existing impression that the results with regard to prognosis are excellent, regardless of how these tumors are treated or not treated. In the ensuing discussion, the need to learn more from collaborative prospective studies regarding the natural history and death rate of untreated small melanomas was emphasized. Most physicians present opted for observation rather than enucleation in most cases of these tumors. For this reason, and because of a reluctance to turn to alternative methods of treatment other than nontreatment or enucleation in this group, the design of randomized clinical trials may be difficult, and participation by clinicians may be limited. A review of registries as a source of information to fill gaps in our knowledge regarding the management of melanomas followed. Ian W. McLean described the AFIP's melanoma collection, which includes 6,000 cases on file, and to which approximately 120 additional cases are added each year. Max Myer discussed the Cancer Surveillance, Epidemiology and End Results (SEER) program, sponsored by the Biometry Branch of the National Cancer Institute. This study, which records data from five states and four metropolitan areas, collected a total of 103 choroidal melanomas between 1973 and 1976, but is, unfortunately, not geared to investigate the unique problems pertinent to this tumor. Daniel Albert described a proposal which has been submitted to the Division of Research Grants of the National Institutes of Health for a collaborative prospective study of uveal melanomas as presently treated, which would involve collaboration effort of centers in Boston, Miami, Cleveland, Iowa City, Madison, Los Angeles, Seattle, and the AFIP. The goal of this study on the course of choroidal melanomas, both treated and untreated, is to provide a scientifically sound basis for the diagnosis and treatment of these tumors. Paul Henkind and others called for the establishment, through the American Academy of Ophthalmology and American Registry of Pathology, of a registry of all untreated cases of melanoma. Next, a review of studies in progress or planned pertinent to the melanoma problem was explored. The first of these described was the Wills Eye Hospital-Ohio State-Oncologic Hospital-AFIP study, which focused on a subgroup of patients with choroidal melanoma having a poor prognosis. The study is intended to evaluate the efficacy of a methanol-extraction residue of BCG, examine histopathologic characteristics relating to metastasis, and explore the sensitivity of various tests for detecting metastatic melanoma. Jerry Shields presented a summary of his ongoing study of ocular melanomas based on the experience of the Oncology Unit at the Wills Eye Hospital which he began in 1974 and which presently includes close to 400 patients.

PY - 1979/3

Y1 - 1979/3

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U2 - 10.1016/0002-9394(79)90091-6

DO - 10.1016/0002-9394(79)90091-6

M3 - Article

C2 - 35004

AN - SCOPUS:0018449017

SN - 0002-9394

VL - 87

SP - 422

EP - 425

JO - American journal of ophthalmology

JF - American journal of ophthalmology

IS - 3

ER -