Benefits and challenges of early detection and treatment of uveal melanoma

A long-standing debate persists regarding whether early detection and treatment of uveal melanoma improve survival or merely provide palliative benefits, given the early dissemination of micrometastases in this aggressive malignancy. This lecture reviews multiple lines of evidence suggesting that early intervention may indeed confer a survival advantage. Data indicate that tumor growth increases the rate of metastasis and that survival differences between small and large tumors with similar genetic profiles cannot be explained solely by differences in the timing of diagnosis. Further analyses reveal that uveal melanomas approximately double in size every 360 days, with small tumors exhibiting longer doubling times and large tumors shorter ones, albeit with considerable variability. This growth pattern implies super-exponential behavior, with larger tumors growing more rapidly as they progress; consequently, even brief delays in treatment may elevate the risk of metastasis for medium-sized and large tumors. Additional studies have shown that certain tumors acquire further driver mutations—such as alterations in BAP1, chromosome 3, and chromosome 8q—during progression, thereby enhancing both aggressiveness and the growth rate of metastases. An international collaboration suggests that early control of the primary tumor may result in extended survival following metastasis. These findings underscore the importance of accurately distinguishing benign choroidal melanocytic lesions from malignant ones when lesions are still small. However, such efforts may strain limited resources and the availability of subspecialized ocular oncologists, as well as lead to the overtreatment of benign lesions with potentially serious consequences for vision and health. Advances in artificial intelligence may support these endeavors.