Now that you see it, what do you do with it? The COMS was a prospective multicenter trial organized by the National Eye Institute in 1985 to examine mortality outcomes of different treatment options for uveal melanoma. They also examined cancer free survival, metastasis free survival, and years of functional vision. There were three main arms of the study, which differentiated melanomas based upon tumor size. It is important to note that this study is not applicable to melanomas of the ciliary body or peripapillary choroid.
Small tumor trial (1mm < height <3mm and 5mm < diameter < 16mm)
Medium tumor trial (2.5mm < height < 10mm and diameter <16mm)
Large tumor trial (height > 8mm and/or diameter > 16mm)
The COMS is a landmark study because it helped guide physicians on when and how to treat ocular melanomas, which are the most common primary eye tumors in adults. Although nonmalignant choroidal nevi are more common than choroidal melanomas, all nevi should be evaluated for features concerning for melanoma as choroidal melanomas have high mortality rates.
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