Gender differences in clinical presentation and prognosis of uveal melanoma

PURPOSE. We examined the clinical differences in manifestation and prognosis of uveal melanoma (UM) between men and women. METHODS. We evaluated 723 UM patients (325 males) who were treated between 1988 and 2010 at a national referral center. Men and women were compared regarding differences in annual distribution, age at diagnosis, size and intraocular location of the tumor, symptoms leading to diagnosis, recurrence, development of metastases, and mortality. Statistical analysis included ANOVA, Pearson correlations, and competing risks for melanoma-related mortality. RESULTS. Significant gender differences were not found for annual distribution, diagnosis age, tumor size, or recurrence rate. Tumors were located more frequently posterior to the equator in men than in women. However, men were less likely than women to complain of symptoms before the diagnosis (77.10% vs. 84.65%). Men suffered more metastases. In the subgroup of patients who had metastases, the time until development of metastases was shorter in men (metastases 1 and 5 years after diagnosis of UM: 26% vs. 12.96% and 84% vs. 50%, respectively). The cumulative incidence for melanomarelated mortality was higher for men, with an almost two-fold excess of male melanoma-related mortality in the first 10 years after the diagnosis of UM. CONCLUSIONS. Men have earlier and more frequent metastases in the first decade after the diagnosis of UM, a fact that may have significant implications in planning clinical trials to test adjuvant therapies to prevent metastasis.