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Abstract
To describe the principal histopathologic findings in a series of 1,527 globes with
uveal melanoma and the relationship of these findings to each other.
All eyes enucleated in the Collaborative Ocular Melanoma Study (COMS) were examined
independently by three ophthalmic pathologists and the findings recorded on a data
form. A composite of findings was obtained after adjudication.
The diagnosis was choroidal melanoma in 1,527 (99.7%) of 1,532 cases examined. Misdiagnoses
were metastatic adenocarcinoma (four) and hemangioma (one). Spindle cell (9.0%), mixed
cell (86.0%), and epithelioid cell (5.0%) types were observed. Medium tumors were
located more posteriorly than large tumors. Considerable local invasion was seen:
rupture of Bruch's membrane (87.7%), invasion of the retina (49.1%), tumor cells in
the vitreous (25.2%), vortex vein invasion (8.9%), invasion of tumor vessels by tumor
cells (13.8%), and invasion into emissary canals (55.0%). Overall, 81.1% demonstrated
local invasion, excluding rupture of Bruch's membrane. Scleral invasion was present
in 55.7% of eyes, and extrascleral extension was present in 8.2%. Mitotic activity
was significantly reduced in eyes that had received preenucleation radiation treatment
(P < .001). The number of macrophages in the tumor increased with increased pigmentation
(P < .001) and increased necrosis (P < .01).
The accuracy of diagnosis in the COMS is high, with histopathologic confirmation of
the diagnosis at 99.7%. Extensive local invasion of the tumor was seen. Preenucleation
irradiation significantly reduced the number of mitotic figures. An association was
found regarding the presence of macrophages, the level of pigmentation, and degree
of necrosis.