Noncontiguous tumor recurrence of posterior uveal melanoma after transscleral local resection.

OBJECTIVE To describe the clinical and histopathologic features of noncontiguous tumor recurrence after transscleral local resection of posterior uveal melanoma. METHODS Chart review was performed to identify patients with noncontiguous tumor recurrences from a series of 494 consecutive patients treated with transscleral local resection for uveal melanoma. The clinical and histopathologic features of noncontiguous tumor recurrences were studied. RESULTS Nine cases were identified, for an estimated incidence of 1.8%. The average diameter of the primary tumors was 16.1 mm (range, 9-22 mm) and the average thickness was 9.8 mm (range, 6-14 mm). Noncontiguous tumor recurrences were solitary in 7 cases and multiple in 2 cases, with an average diameter of 5.8 mm (range, 3.0-9.5 mm). Eight of the 9 patients developed tumor recurrences at multiple intraocular sites. With a mean follow-up of 82.1 months (range, 22-171 months), 7 patients had a final visual acuity of counting fingers or worse, and there were 3 deaths from metastatic disease. CONCLUSIONS Noncontiguous tumor recurrence after local resection appears to be related to intraocular dissemination from the primary tumor, either through the natural course of the disease or secondary to surgical manipulation. Eyes with large primary uveal melanomas developing noncontiguous tumor recurrence have a high risk of developing tumor spread to multiple intraocular sites, and aggressive treatment is warranted.