Treatment for Metastatic Uveal Melanoma?

Many of us have seen one or more patients with uveal melanoma, a condition which is virtually a death sentence if it metastasizes as is often the case. In the past decade. Memorial Sloan-Kettering Cancer Center in NY has greatly expanded its ophthalmic oncology division and has just announced a clinical trial of an investigative MEK inhibitor for the treatment of metastatic uveal melanoma (MUM). David Abramson, MD, a brilliant and highly experienced research clinician, is the Chief of Ophthalmic Oncology at MSK. Dr. Abramson is encouraging optometrists and ophthalmologists nationwide to inform their patients with MUM about this new clinical trial.

At a recent meeting. Dr. Abramson pointed out to me (JS) that virtually all nevi are acquired and hence must grow at some point. He has performed over 13,000 examinations under anesthesia for young children, and has only seen a choroidal nevus in a child once — a child with an unusual chromosome deletion. In spite of this, when we clinically document growth, we clinicians “grow” concerned as we should. Growth, size, thickness and associated findings (such as lipofuscin) should be considered. B- scan ultrasound is the simple and traditional way to assess thickness of lesions in these patients. The vast majority of nevi are too thin to detect with B-scan. If a lesion is detected, it is likely greater than 1 mm in thickness and more likely to be a melanoma. SD OCT can easily document elevations of 100 u or so in lesions that are not detected with B- scan. The new MUM study requires that metastasis—as defined in a traditional fashion—has been documented before the patient can enter the trial. But micro-metastasis to the liver often occurs early yet is not detectable. Although many of us would prefer to treat patients earlier than the study presently permits, this clinical trial is a giant first step. If you encounter a patient with MUM, please contact:

David H. Abramson, MD, FACS
Chief, Ophthalmic Oncology
Memorial Sloan-Kettering Cancer Center
(P) 212-744-1700 (Park Ave Office)
(P) 212-639-7232 (MSK Campus)
Beeper 6625
Abramsod@MSKCC.ORG