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Dennis M. Robertson, MD

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Damato states that in a 2008 publication, "Shields observed that tumor size is a poor predictor of metastasis." In fact, in the publication that Damato cites¹ Shields et al list a tumor thickness of 2 mm or larger as the first among several other risk factors for metastasis. This appears unchanged from a 1995 article by the same oncology group² in which increased tumor thickness was identified as a predictor of metastasis.

The Collaborative Ocular Melanoma Study Group (COMS) also verified the relationship of increasing tumor size to metastasis.^3-5

Damato is rather presumptuous in suggesting that the rates of metastases reported by the COMS for small choroidal melanomas were lower than they should be because COMS investigators "probably" included many nevi among the melanomas. Unless better information becomes available, it is reasonable to conclude that the rate of metastases for small melanomas reported by . . . [Full Text of this Article]

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