{'fraction_non_alphanumeric': 0.01587849499482223, 'fraction_numerical': 0.012426648256817397, 'mean_word_length': 5.646788990825688, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Is Surveillance of Uveal Melanoma Just a Screen?

Despite the realization that half of patients with uveal melanomawill ultimatelydevelopmetastaticdisease, questions remain regarding theutility of routine surveillance. In2011, a literature review of 31 articles failed to demonstrate convincing evidence of a survival advantage from routine surveillance.1 However, these studies were conducted in the context of traditional chemotherapy regimens, none of which demonstrated adequate response rates for uvealmelanoma.Aphase 2 trial of selumetinib conductedbetween2010 and 2013 yielded improved response rates and progressionfreesurvival (despiteno improvement inoverall survival) compared with chemotherapy.2 These landmark findings shed somehope on the dismal landscape ofmetastatic uvealmelanoma andhave thus reignited the potential benefit of routine surveillance and early detection of disease. For this reason, establishing the optimal surveillance method for uveal melanoma, should it prove to be meaningful, is an important proposition. Key characteristics of a screening regimen include adequate sensitivity and specificity as well as balancing the toxicity of the screening examination with the financial and emotional costs. Because 90% of metastases are first recognized in the liver, it is logical to focus on tests of the liver. Computed tomography is limited by its emission of radiation (especially if repeated every 6-12 months for many years) and the very high incidence of false-positive results.3 While magnetic resonance imaging (MRI) is perceived as being the most sensitive test, it is expensive and less accessible and also has many false-positive results. As Choudhary et al4 have pointed out in this issue of JAMA Ophthalmology, abdominal ultrasonography is an attractive screening modality. Historically, owing to its operator dependence and limitation by body habitus, abdominal ultrasonography was rarely used as a surveillance tool in the United States and has been more commonly adopted in Europe.5,6 Almost a decade ago, a study from Finland estimated that semiannual ultrasonography in concert with liver function tests could detect metastases in more than 95% of asymptomatic patients.6 At the time, the authors could not justify the expense of such a regimen in the face of poor response from the conventional chemotherapy used at the time.6 However, the promising results of targeted and immunotherapy treatments for metastatic disease2,7 may now justify an exploration of this proposed screening regimen. The work of Choudhary et al4 is most intriguing because it addresses themodel that was raised by the Finnish study a decade ago, in a US population that was historically believed to be less eligible for such a screening approach. The authors Related article page 174 Research Original Investigation Hepatic Ultrasonography for Surveillance in Uveal Melanoma