I'm an ocular pathologist and this is my opinion, and not of SDN's. The following is not medical advice, but an academic opinion on the following topic.
I know the COMS study showed that enucleation and plaque implant are equal in terms of survivial but is that dependent upon liver status?
The COMS didn't look at this.
What's the survival rate for all-comers?
What about if liver is +?
What about negative?
The COMS didn't look at the prognosis when the melanoma spread outside the eye. Unfortunately, the prognsis not good. The COMS looked at tumor size and location. In addition to tumor size, location, cell type (i.e., spindle A (most benign = nevus), spindle B, mixed cell (spindle+epithelioid), or epithelioid) is extremely important in determining prognosis.
Here are the results of the COMS (
http://www.nei.nih.gov/neitrials/viewStudyWeb.aspx?id=23)
Nonrandomized Small Tumor Pilot Study
The treatment and mortality results of the COMS nonrandomized small tumor pilot study were reported in 1997. From December 1986 to August 1989, 204 patients with small choroidal melanoma, defined as 1.0 to 3.0 mm in apical height and at least 5.0 mm in basal diameter, were enrolled in a prospective followup study. The median length of followup was 92 months. Eight percent of patients were treated at the time of study enrollment and an additional 33 percent were treated during followup. Based on 27 deaths, the Kaplan-Meier estimate of five-year all-cause mortality was 6.0 percent (95 percent confidence interval, 2.7 percent - 9.3 percent) and eight-year all-cause mortality was 14.9 percent (95 percent confidence interval, 9.6 percent - 20.2 percent). Mortality findings and analysis of predictors of growth have been published (COMS Reports Nos. 4 and 5).
The Randomized Trial of Pre-Enucleation Radiation for Large Choroidal Melanoma
Initial mortality findings published in 1998 (COMS Report No. 10) showed that patients with large choroidal melanoma had similar survival rates regardless of whether they were treated with radiation prior to removal of the eye or had their eye removed without prior radiation therapy. Five-year survival rates were approximately 60 percent in both treatment arms. The COMS large tumor trial found neither benefit nor harm from treating ocular melanoma patients with radiation before removal of the eye. However, patients who had pre-enucleation radiation had fewer local complications (COMS Report No. 11).
The Randomized Trial of I-125 Brachytherapy for Medium Choroidal Melanoma
Initial mortality findings published in 2001 (COMS Report No. 18) showed that survival rates for radiation therapy (I-125 brachytherapy) and enucleation (removal of the eye) are about the same. The five-year survival rate of patients who were treated with either radiation therapy or eye removal was 82 percent, considerably better than the 70 percent five-year survival rate that had been projected when the study was designed in 1985. Compared to immediate loss of vision when the eye is removed, eyes treated with radiation steadily lost vision gradually, with 63 percent having visual acuity of 20/200 or worse by three years after treatment (COMS Report No. 16).
Based on the COMS, large tumors (i.e. tumors greater than 10 mm in greatest dimension) have a five-year survival rate of approximately 60 percent.
Uveal melanoma metastasizes in ~45% of patients within 15 years. The liver is involved in more than 90% of cases of metastatic uveal melanoma followed by lung. Once metastases develop, the prognosis with currently available therapies is poor. One-year survival rates of 15-40% have been reported; and although current treatments can slow down the metastatic growth, three year survival in recent studies does not exceed 5%.
Here is a good review from a dissertation:
http://ethesis.helsinki.fi/julkaisut/laa/kliin/vk/puusaari/iodinebr.pdf
I hope this is the information that you're seeking, and I am sorry about your wife's uncle.
