Recommended systemic screening for patients with uveal melanoma who have undergone brachytherapy or enucleation
The process
Initial screening (at diagnosis) may be done by an ocular oncologist (ophthalmologist) or oncologist.
Follow-up screening (physical examinations and imaging) should be done by an oncologist. If an oncologist is not readily available, the patient may see a physician or family physician.
Follow-up should consist of history and physical exam, chemistry, and imaging based on patient risk categories:
Patients with cytogenetic testing which displays disomy 3 (monosomy 3 negative or undetected) OR patients with no cytogenetic assessment and tumour <8 mm thick:
o Physical exam: annually, indefinitely
o Chest X-ray: annually, indefinitely
o Bloodwork: liver function tests, annually indefinitely
o Liver U/S: annually, indefinitely
o Follow-up may be transitioned to the family physician at 5 years.
Patients with cytogenetic testing which displays monosomy 3 OR tumours >8mm thick with no cytogenetic assessment:
o Physical exam: annually, indefinitely
o Chest X-ray: annually, indefinitely
o Bloodwork: liver function tests, annually indefinitely
o Annual liver U/S alternating with annual MRI liver for ten years, then yearly liver ultrasound indefinitely. If body habitus limits U/S, consideration for other modalities should be given.
o Follow-up may be transitioned to the family physician at 10 years.
Tumour size and regression following brachytherapy treatment is measured by ultrasound (10MHz B-scan and 35 MHz UBM) at ophthalmologic assessments, which are 4-monthly for the first 2 years, then usually decreased to 6-monthly thereafter.
No routine neuro-imaging is required following brachytherapy unless the oncologist/physician has a separate indication for this.