Systemic Surveillance Guidelines for Uveal Melanoma: A Systematic Review.

Abstract

Background: Uveal melanoma (UM) is the most common primary intraocular tumour. Despite effective local therapies, UM has a high risk of metastatic recurrence, most frequently to the liver. A significant proportion of patients treated definitively for primary UM eventually experience metastatic disease. Systemic surveillance to detect recurrence is critical to maximise therapeutic options. Whilst international guidelines exist, there are currently no standardised Australian guidelines for surveillance imaging. This systematic review examines the literature regarding systemic surveillance methods following local treatment for UM.

Methods: Medline, Embase and PubMed databases were searched, from 2010 to 01-07-2024, using keywords related to uveal melanoma and surveillance. Eligible studies were identified by two independent reviewers, and a systematic review was undertaken.

Results: Of 840 records, six guidelines and institutional consensus statements were identified, and an additional 13 studies were included. Most studies were cohort studies (n = 7), with the rest being case-control studies and reliability analyses. Risk stratification methods and surveillance strategies varied, with most studies recommending increased frequency (at least every 6 months) and higher-resolution imaging modalities (MRI over ultrasound) for higher-risk patients.

Conclusion: Despite several published guidelines, existing evidence regarding optimal surveillance strategies in localised primary UM is of variable quality, relying on cohort studies and limited by heterogeneity, as assessed by the modified Newcastle-Ottawa Scale. There is a clear need to further define local practices and outcomes to direct future guidelines.