Cancer is a life-threatening disease in which early detection and treatment is the standard of care.Yet, the eye cancer community continues to debate the merits of early detection and treatment of small but suspicious choroidal nevi. Some ocular oncologists are diagnosing and treating extremely small lesions. Others advocate a wait-and-see approach in which growth indicates malignancy and therefore treatment.
This conversation is taking place while 50% of the patient population dies at 10 to 15 years, a mortality rate that is unchanged despite treatment advances. Since the incidence rates in both the U.S. and Europe are also unchanged, it raises the question as to whether we are catching and treating this rare cancer in time to save the life of the patient.
Under either the COMS or American Joint Committee on Cancer (AJCC) tumor classifications, small choroidal melanomas - when the threat to life is the lowest - are lesions that are less than 3 mm thick and at least 7 mm in diameter.
The TFSOM clinical standard (click on above graphic to view larger image) found that the risk of malignant growth is 50% when 2 or more factors are present. Therefore, waiting for growth when malignant conditions already exist, is begging the question.
Why does size matter? Genetic research is showing that uveal melanomas may acquire more chromosomal defects as they grow, leading to a higher risk of metastatic death. Currently, there is no treatment for metastatic uveal melanoma with the average time of diagnosis to death being 7 to 12 months in unresectable tumors.
Without clear agreement and direction from the ocular oncology community, downstream providers, such as family practitioners, general ophthalmologists and optometrists, will fail to recognize these lesions as early cancers and refer out these patients for specialized sight and life-saving care.
Since a ‘growth’ management philosophy may be potentially devastating on a patient’s outcome, See A Cure urges individuals presenting with small but suspicious choroidal lesions to be informed about the TFSOM standard and the diagnosing controversy so that they can either partner with their doctor - or obtain a second opinion - on their sight and life decision.
2 comments:
I was diagnosed with a 'nevus' in 1993 (15 year ago). It was ands still is 6.5x5.5x1.2 mm. It has orange pigment and fluid. It is near my center of vision and I am about 20/30 to 20/40 in that eye. It has not grown for 15 years, but with the advent of TFSOM, I am considering treatment before it grows. Mets, of course, is the concern here. I have heard there may be serious side effects with radiation and since I would lose most all of my vision in that eye anyway, I am planning on enucleation. Is anyone else in a similar situation?
I know you wrote this awhile ago, so you may have already been treated. I wanted to let you know that there are others out there in a similar situation.
I also have a nevus that's been watched for the past 2 years with no growth. I see an ocular oncologist yearly because it has been labeled "suspicious." Have you seen a specialist? Because this is such a rare cancer, not all optometrists have experience with it. There's a Choroidal Melanoma group on Yahoo where people share their experiences. It's been helpful for me, and maybe you would also find it to be a helpful place.
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