A 65-year-old patient with uveal melanoma of the ciliary body shows extrascleral extension on MRI. The Collaborative Ocular Melanoma Study (COMS) findings most relevant to medium-sized choroidal melanoma management are:
- A Enucleation was superior to plaque brachytherapy in local control and overall survival for medium tumors
- B Pre-enucleation external beam radiotherapy reduced metastatic rate by 50% compared to enucleation alone
- C Iodine-125 plaque brachytherapy for medium tumors produced equivalent melanoma-related mortality to enucleation at 12 years ✓
- D Proton beam therapy was the superior modality studied in COMS for medium tumors
Correct answer: C. Iodine-125 plaque brachytherapy for medium tumors produced equivalent melanoma-related mortality to enucleation at 12 years
Explanation
The COMS (Collaborative Ocular Melanoma Study) randomized medium-sized choroidal melanomas (2.5–10 mm height, up to 16 mm basal diameter) to either iodine-125 brachytherapy or enucleation. The 12-year follow-up showed no statistically significant difference in melanoma-related mortality between the two groups (~21% at 12 years in both arms). This established I-125 brachytherapy as the standard eye-conserving treatment for medium uveal melanoma. The COMS also showed that pre-enucleation radiotherapy did not reduce mortality for large tumors.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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