Recommendations for baseline medical evaluation in patients with known or suspected uveal melanoma

If you have been diagnosed as having a cancerous intraocular tumor known as a uveal malignant melanoma, or if you are suspected of having that tumor, an evaluation with your internal medicine doctor or medical oncologist should be performed.

This form of eye cancer has a well-known tendency to spread (metastasize) via the bloodstream to various organs in the body.  The most common metastatic sites are the liver, skin, and lungs.  Fortunately, most patients with a uveal malignant melanoma do not have any detectable metastatic tumors at the time of diagnosis and treatment of the eye melanoma.  Moreover, many patients with a uveal malignant melanoma never develop metastatic tumors.

Unfortunately, however, some patients who have an ocular tumor of this type but no detectable metastatic tumors on baseline evaluation eventually develop clinically apparent metastatic tumors.  This can happen even if the affected eye was removed, the tumor was excised surgically from the eye, or the tumor was destroyed in place by methods such as plaque radiotherapy, laser therapy or cryotherapy.

The explanation for this phenomenon is generally believed to be the presence of microscopic or submicroscopic metastatic tumor cells that are not detectable by physical examination and conventional testing at the time of the baseline medical evaluation.

Depending on the organs affected, the number of metastatic tumors, the size and growth rates of these tumors, and the response of those tumors to treatments, such as metastatic tumors may prove fatal.  If metastatic tumors are detected at follow-up examination, you will be advised about available options for treating those tumors at that time.

The following baseline studies are generally recommended prior to any treatment for the eye tumor.

Complete physical examination
A detailed review of your medical-surgery history and a comprehensive physical examination are usually advised as baseline studies to evaluate uveal malignant melanoma patients for evidence of liver enlargement, metastatic tumors in or under the surface of the skin, or any other abnormalities suspicious for metastatic disease.

Blood tests
Blood tests are also generally recommended prior to treatment of patients with an intraocular malignant melanoma.  The tests usually preformed include complete and differential blood courts and blood tests for liver enzyme (protein) levels (especially ones abbreviated as LDH and GGT) that can be elevated in metastatic uveal melanoma to the liver.  Many conditions other than metastatic malignant melanoma can affect the blood counts and enzyme levels, but any unexplained abnormal results of these tests deserve further investigation.

Chest x-ray
A baseline chest x-ray is usually recommended in conjunction with the baseline physical examination.  The purpose of such testing is to detect or rule out clinically significant metastatic tumors to the lungs or unsuspected asymptomatic non-melanoma lesions.

MRI or CT scan of the abdomen, or a PET scan
A baseline MRI, CT, or PET scan of the liver and other abdominal organs is advised in patients with a uveal malignant melanoma.  Occasionally, tumors that are too small to produce abnormalities of the blood tests will be identified by such studies.