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<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Childhood Intraocular (Uveal) Melanoma Treatment (PDQ®) - PDQ Cancer Information Summaries - NCBI Bookshelf</title>
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</svg> Books</a></div><div class="jr-rhead f1 flexh"><div class="head"></div><div class="body"><div class="t">Childhood Intraocular (Uveal) Melanoma Treatment (PDQ®): Health Professional Version</div><div class="j">PDQ Cancer Information Summaries [Internet]</div></div><div class="tail"></div></div><div id="jr-tb2"><a id="jr-bkhelp-sw" class="btn wsprkl hidden" title="Help with NLM PubReader">?</a><a id="jr-help-sw" class="btn wsprkl hidden" title="Settings and typography in NLM PubReader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512" preserveAspectRatio="none"><path d="M462,283.742v-55.485l-29.981-10.662c-11.431-4.065-20.628-12.794-25.274-24.001 c-0.002-0.004-0.004-0.009-0.006-0.013c-4.659-11.235-4.333-23.918,0.889-34.903l13.653-28.724l-39.234-39.234l-28.72,13.652 c-10.979,5.219-23.68,5.546-34.908,0.889c-0.005-0.002-0.01-0.003-0.014-0.005c-11.215-4.65-19.933-13.834-24-25.273L283.741,50 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id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK552282_"><span class="title" itemprop="name">Childhood Intraocular (Uveal) Melanoma Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Health Professional Version</div><p class="contribs">PDQ Pediatric Treatment Editorial Board.</p><p class="fm-aai"><a href="#_NBK552282_pubdet_">Publication Details</a></p></div></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000800111__1556">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of pediatric intraocular (uveal) melanoma. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions.</p><p id="CDR0000800111__1557">This summary is reviewed regularly and updated as necessary by the PDQ Pediatric Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p></div><div id="CDR0000800111__1608"><h2 id="_CDR0000800111__1608_">Incidence</h2><p id="CDR0000800111__1609">Uveal melanoma (iris, ciliary body, choroid) is the most common primary intraocular malignancy. About 2,000 cases of uveal melanoma are diagnosed each year in the United States. It accounts for 5% of all cases of melanoma.[<a class="bibr" href="#CDR0000800111_rl_1608_1" rid="CDR0000800111_rl_1608_1">1</a>] This tumor is most commonly diagnosed in older patients, and the incidence peaks at age 70 years.[<a class="bibr" href="#CDR0000800111_rl_1608_2" rid="CDR0000800111_rl_1608_2">2</a>]</p><p id="CDR0000800111__1610">Pediatric uveal melanoma is extremely rare and accounts for 0.8% to 1.1% of all cases of uveal melanoma.[<a class="bibr" href="#CDR0000800111_rl_1608_3" rid="CDR0000800111_rl_1608_3">3</a>] A retrospective, 24-center, observational study conducted by the European Ophthalmic Oncology Group from 1968 to 2014 identified 114 children (aged 1–17 years) and 185 young adults (aged 18–25 years) with ocular melanoma.[<a class="bibr" href="#CDR0000800111_rl_1608_3" rid="CDR0000800111_rl_1608_3">3</a>] The median age at diagnosis for children was 15.1 years. The incidence of disease increased by 0.8% per year between the ages of 5 and 10 years and 8.8% per year between the ages of 17 and 24 years. Other series have also documented the higher incidence of the disease in adolescents.[<a class="bibr" href="#CDR0000800111_rl_1608_4" rid="CDR0000800111_rl_1608_4">4</a>,<a class="bibr" href="#CDR0000800111_rl_1608_5" rid="CDR0000800111_rl_1608_5">5</a>]</p><div id="CDR0000800111_rl_1608"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000800111_rl_1608_1">Field MG, Harbour JW: Recent developments in prognostic and predictive testing in uveal melanoma. Curr Opin Ophthalmol 25 (3): 234-9, 2014. [<a href="/pmc/articles/PMC4467564/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4467564</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24713608" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24713608</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_1608_2">Singh AD, Bergman L, Seregard S: Uveal melanoma: epidemiologic aspects. Ophthalmol Clin North Am 18 (1): 75-84, viii, 2005. [<a href="https://pubmed.ncbi.nlm.nih.gov/15763193" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15763193</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_1608_3">Al-Jamal RT, Cassoux N, Desjardins L, et al.: The Pediatric Choroidal and Ciliary Body Melanoma Study: A Survey by the European Ophthalmic Oncology Group. Ophthalmology 123 (4): 898-907, 2016. [<a href="https://pubmed.ncbi.nlm.nih.gov/26854035" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26854035</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_1608_4">Shields CL, Kaliki S, Arepalli S, et al.: Uveal melanoma in children and teenagers. Saudi J Ophthalmol 27 (3): 197-201, 2013. [<a href="/pmc/articles/PMC3770213/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3770213</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24227986" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24227986</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_1608_5">Pogrzebielski A, Orłowska-Heitzman J, Romanowska-Dixon B: Uveal melanoma in young patients. Graefes Arch Clin Exp Ophthalmol 244 (12): 1646-9, 2006. [<a href="https://pubmed.ncbi.nlm.nih.gov/16636835" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16636835</span></a>]</div></li></ol></div></div><div id="CDR0000800111__2461"><h2 id="_CDR0000800111__2461_">Risk Factors</h2><p id="CDR0000800111__1611">Risk factors for developing uveal melanoma include the following:[<a class="bibr" href="#CDR0000800111_rl_2461_1" rid="CDR0000800111_rl_2461_1">1</a>-<a class="bibr" href="#CDR0000800111_rl_2461_3" rid="CDR0000800111_rl_2461_3">3</a>]</p><ul id="CDR0000800111__1612"><li class="half_rhythm"><div>Light eye color.</div></li><li class="half_rhythm"><div>Fair skin color.</div></li><li class="half_rhythm"><div>Inability to tan.</div></li><li class="half_rhythm"><div>Oculodermal melanocytosis.</div></li><li class="half_rhythm"><div>Presence of cutaneous nevi.</div></li></ul><p id="CDR0000800111__1613">In a European Oncology Group study, 57% of the pediatric patients were female. Four patients had a preexisting condition that included oculodermal melanocytosis (n = 2) and neurofibromatosis (n = 2).[<a class="bibr" href="#CDR0000800111_rl_2461_4" rid="CDR0000800111_rl_2461_4">4</a>] In a review of 13 cases of uveal melanoma in the first 2 years of life, four patients had familial atypical melanoma mole syndrome, one patient had dysplastic nevus syndrome, and one patient had café au lait spots.[<a class="bibr" href="#CDR0000800111_rl_2461_5" rid="CDR0000800111_rl_2461_5">5</a>]</p><div id="CDR0000800111_rl_2461"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000800111_rl_2461_1">Weis E, Shah CP, Lajous M, et al.: The association between host susceptibility factors and uveal melanoma: a meta-analysis. Arch Ophthalmol 124 (1): 54-60, 2006. [<a href="https://pubmed.ncbi.nlm.nih.gov/16401785" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16401785</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_2461_2">Weis E, Shah CP, Lajous M, et al.: The association of cutaneous and iris nevi with uveal melanoma: a meta-analysis. Ophthalmology 116 (3): 536-543.e2, 2009. [<a href="https://pubmed.ncbi.nlm.nih.gov/19167086" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19167086</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_2461_3">Singh AD, De Potter P, Fijal BA, et al.: Lifetime prevalence of uveal melanoma in white patients with oculo(dermal) melanocytosis. Ophthalmology 105 (1): 195-8, 1998. [<a href="https://pubmed.ncbi.nlm.nih.gov/9442799" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9442799</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_2461_4">Al-Jamal RT, Cassoux N, Desjardins L, et al.: The Pediatric Choroidal and Ciliary Body Melanoma Study: A Survey by the European Ophthalmic Oncology Group. Ophthalmology 123 (4): 898-907, 2016. [<a href="https://pubmed.ncbi.nlm.nih.gov/26854035" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26854035</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_2461_5">Yousef YA, Alkilany M: Characterization, treatment, and outcome of uveal melanoma in the first two years of life. Hematol Oncol Stem Cell Ther 8 (1): 1-5, 2015. [<a href="https://pubmed.ncbi.nlm.nih.gov/25300563" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25300563</span></a>]</div></li></ol></div></div><div id="CDR0000800111__1614"><h2 id="_CDR0000800111__1614_">Molecular Features</h2><p id="CDR0000800111__1615">Uveal melanoma is characterized by activating variants of <i>GNAQ</i> and <i>GNA11</i>, which lead to activation of the mitogen-activated protein kinases (MAPK) pathway. In addition, variants in <i>BAP1</i> are seen in 84% of metastasizing tumors. Variants in <i>SF3B1</i> and <i>EIF1AX</i> are associated with a good prognosis.[<a class="bibr" href="#CDR0000800111_rl_1614_1" rid="CDR0000800111_rl_1614_1">1</a>-<a class="bibr" href="#CDR0000800111_rl_1614_6" rid="CDR0000800111_rl_1614_6">6</a>]</p><div id="CDR0000800111_rl_1614"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000800111_rl_1614_1">Van Raamsdonk CD, Griewank KG, Crosby MB, et al.: Mutations in GNA11 in uveal melanoma. N Engl J Med 363 (23): 2191-9, 2010. [<a href="/pmc/articles/PMC3107972/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3107972</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21083380" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21083380</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_1614_2">Harbour JW, Onken MD, Roberson ED, et al.: Frequent mutation of BAP1 in metastasizing uveal melanomas. Science 330 (6009): 1410-3, 2010. [<a href="/pmc/articles/PMC3087380/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3087380</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21051595" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21051595</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_1614_3">Gupta MP, Lane AM, DeAngelis MM, et al.: Clinical Characteristics of Uveal Melanoma in Patients With Germline BAP1 Mutations. JAMA Ophthalmol 133 (8): 881-7, 2015. [<a href="https://pubmed.ncbi.nlm.nih.gov/25974357" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25974357</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_1614_4">Harbour JW, Roberson ED, Anbunathan H, et al.: Recurrent mutations at codon 625 of the splicing factor SF3B1 in uveal melanoma. Nat Genet 45 (2): 133-5, 2013. [<a href="/pmc/articles/PMC3789378/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3789378</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23313955" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23313955</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_1614_5">Martin M, Maßhöfer L, Temming P, et al.: Exome sequencing identifies recurrent somatic mutations in EIF1AX and SF3B1 in uveal melanoma with disomy 3. Nat Genet 45 (8): 933-6, 2013. [<a href="/pmc/articles/PMC4307600/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4307600</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23793026" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23793026</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_1614_6">Van Raamsdonk CD, Bezrookove V, Green G, et al.: Frequent somatic mutations of GNAQ in uveal melanoma and blue naevi. Nature 457 (7229): 599-602, 2009. [<a href="/pmc/articles/PMC2696133/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2696133</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/19078957" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19078957</span></a>]</div></li></ol></div></div><div id="CDR0000800111__2405"><h2 id="_CDR0000800111__2405_">Prognostic Factors</h2><p id="CDR0000800111__2406">Prognostic factors for uveal melanoma include the following:[<a class="bibr" href="#CDR0000800111_rl_2405_1" rid="CDR0000800111_rl_2405_1">1</a>,<a class="bibr" href="#CDR0000800111_rl_2405_2" rid="CDR0000800111_rl_2405_2">2</a>]</p><ul id="CDR0000800111__2407"><li class="half_rhythm"><div>Tumor size.</div></li><li class="half_rhythm"><div>Age. In one series, children experienced a lower overall metastatic rate than adults (at both 10 and 20 years).[<a class="bibr" href="#CDR0000800111_rl_2405_1" rid="CDR0000800111_rl_2405_1">1</a>]</div></li><li class="half_rhythm"><div>Ciliary body involvement.</div></li><li class="half_rhythm"><div>Tumor outside the sclera.</div></li><li class="half_rhythm"><div>Metastasis.</div></li><li class="half_rhythm"><div>Genetic changes. For more information, see the <a href="#CDR0000800111__1614">Molecular Features</a> section.</div></li></ul><p id="CDR0000800111__1618">The survival of children appears to be more favorable than that of young adults and adults, suggesting that the biology of ocular melanoma might be different in children.[<a class="bibr" href="#CDR0000800111_rl_2405_1" rid="CDR0000800111_rl_2405_1">1</a>,<a class="bibr" href="#CDR0000800111_rl_2405_2" rid="CDR0000800111_rl_2405_2">2</a>]</p><p id="CDR0000800111__2467"> A retrospective, multicenter, cohort study identified 133 young children aged 1 to 12 years with choroidal or ciliary body (n = 66; 50%), iris (n = 33; 25%), conjunctival (n = 26; 19%), and eyelid (n = 8; 6%) melanomas.[<a class="bibr" href="#CDR0000800111_rl_2405_3" rid="CDR0000800111_rl_2405_3">3</a>]</p><ul id="CDR0000800111__2468"><li class="half_rhythm"><div>Metastasis was seen in the following:<ul id="CDR0000800111__2469"><li class="half_rhythm"><div>12% of patients with choroid/ciliary body melanomas (mean follow-up, 74 months).</div></li><li class="half_rhythm"><div> 9% of patients with iris melanomas (mean follow-up, 85 months).</div></li><li class="half_rhythm"><div>19% of patients with conjunctival melanomas (mean follow-up, 50 months).</div></li><li class="half_rhythm"><div>13% of patients with eyelid melanomas (mean follow-up, 105 months) (<i>P</i> = .65).</div></li></ul></div></li><li class="half_rhythm"><div>Death was reported in the following: <ul id="CDR0000800111__2470"><li class="half_rhythm"><div>5% of patients with choroid/ciliary body melanomas.</div></li><li class="half_rhythm"><div>3% of patients with iris melanomas.</div></li><li class="half_rhythm"><div>8% of patients with conjunctival melanomas.</div></li><li class="half_rhythm"><div>0% of patients with eyelid melanomas.</div></li></ul></div></li></ul><div id="CDR0000800111_rl_2405"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000800111_rl_2405_1">Al-Jamal RT, Cassoux N, Desjardins L, et al.: The Pediatric Choroidal and Ciliary Body Melanoma Study: A Survey by the European Ophthalmic Oncology Group. Ophthalmology 123 (4): 898-907, 2016. [<a href="https://pubmed.ncbi.nlm.nih.gov/26854035" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26854035</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_2405_2">Shields CL, Kaliki S, Arepalli S, et al.: Uveal melanoma in children and teenagers. Saudi J Ophthalmol 27 (3): 197-201, 2013. [<a href="/pmc/articles/PMC3770213/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3770213</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24227986" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24227986</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_2405_3">Masoomian B, Dalvin LA, Riazi-Esfahani H, et al.: Pediatric ocular melanoma: a collaborative multicenter study and meta-analysis. J AAPOS 27 (6): 316-324, 2023. [<a href="https://pubmed.ncbi.nlm.nih.gov/37949393" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 37949393</span></a>]</div></li></ol></div></div><div id="CDR0000800111__1864"><h2 id="_CDR0000800111__1864_">Special Considerations for the Treatment of Children With Cancer</h2><p id="CDR0000800111__1864_md_3">Cancer in children and adolescents is rare, although the overall incidence has slowly increased since 1975.[<a class="bibr" href="#CDR0000800111_rl_1864_1" rid="CDR0000800111_rl_1864_1">1</a>] Children and adolescents with cancer should be referred to medical centers that have a multidisciplinary team of cancer specialists with experience treating the cancers that occur during childhood and adolescence. This multidisciplinary team approach incorporates the skills
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of the following pediatric specialists and others to ensure that children receive treatment, supportive care, and rehabilitation
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to achieve optimal survival and quality of life:</p><ul id="CDR0000800111__1864_md_4"><li class="half_rhythm"><div>Primary care physicians.</div></li><li class="half_rhythm"><div>Pediatric surgeons.</div></li><li class="half_rhythm"><div>Pathologists.</div></li><li class="half_rhythm"><div>Pediatric radiation
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oncologists.</div></li><li class="half_rhythm"><div>Pediatric medical oncologists and hematologists.</div></li><li class="half_rhythm"><div>Ophthalmologists.</div></li><li class="half_rhythm"><div> Rehabilitation
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specialists.</div></li><li class="half_rhythm"><div>Pediatric oncology nurses.</div></li><li class="half_rhythm"><div>Social workers.</div></li><li class="half_rhythm"><div>Child-life professionals.</div></li><li class="half_rhythm"><div>Psychologists.</div></li><li class="half_rhythm"><div>Nutritionists.</div></li></ul><p id="CDR0000800111__1864_md_5">For specific information about supportive care for children and adolescents with cancer, see the summaries on <a href="https://www.cancer.gov/publications/pdq/information-summaries/supportive-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Supportive and Palliative Care</a>.</p><p id="CDR0000800111__1864_md_6">The American Academy of Pediatrics has outlined guidelines for
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pediatric cancer centers and their role in the treatment of children and adolescents
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with cancer.[<a class="bibr" href="#CDR0000800111_rl_1864_2" rid="CDR0000800111_rl_1864_2">2</a>] At
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these centers, clinical trials are available for most types of cancer that occur in children and adolescents, and the opportunity
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to participate is offered to most patients and their families. Clinical
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trials for children and adolescents diagnosed with cancer are generally
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designed to compare potentially better therapy with current standard therapy. Other types of clinical trials test novel therapies when there is no standard therapy for a cancer diagnosis. Most of the progress in identifying curative
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therapies for childhood cancers has been achieved through clinical trials.
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Information about ongoing clinical trials is available from the <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p><p id="CDR0000800111__1864_md_7">Dramatic improvements in survival have been achieved for children and adolescents with cancer. Between 1975 and 2020, childhood cancer mortality decreased by more than 50%.[<a class="bibr" href="#CDR0000800111_rl_1864_3" rid="CDR0000800111_rl_1864_3">3</a>-<a class="bibr" href="#CDR0000800111_rl_1864_5" rid="CDR0000800111_rl_1864_5">5</a>] Childhood and adolescent cancer survivors require close monitoring because side effects of cancer therapy may persist or develop months or years after treatment. For information about the incidence, type, and monitoring of late effects in childhood and adolescent cancer survivors, see <a href="/books/n/pdqcis/CDR0000343584/?report=reader">Late Effects of Treatment for Childhood Cancer</a>.</p><p id="CDR0000800111__1864_md_8">Childhood cancer is a rare disease, with about 15,000 cases diagnosed annually in the United States in individuals younger than 20 years.[<a class="bibr" href="#CDR0000800111_rl_1864_6" rid="CDR0000800111_rl_1864_6">6</a>] The U.S. <a href="https://www.congress.gov/107/plaws/publ280/PLAW-107publ280.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Rare Diseases Act of 2002</a> defines a rare disease as one that affects populations smaller than 200,000 people in the United States. Therefore, all pediatric cancers are considered rare.</p><p id="CDR0000800111__1864_md_9">The designation of a rare tumor is not uniform among pediatric and adult groups. In adults, rare cancers are defined as those with an annual incidence of fewer than six cases per 100,000 people. They account for up to 24% of all cancers diagnosed in the European Union and about 20% of all cancers diagnosed in the United States.[<a class="bibr" href="#CDR0000800111_rl_1864_7" rid="CDR0000800111_rl_1864_7">7</a>,<a class="bibr" href="#CDR0000800111_rl_1864_8" rid="CDR0000800111_rl_1864_8">8</a>] In children and adolescents, the designation of a rare tumor is not uniform among international groups, as follows:</p><ul id="CDR0000800111__1864_md_10"><li class="half_rhythm"><div class="half_rhythm">A consensus effort between the European Union Joint Action on Rare Cancers and the European Cooperative Study Group for Rare Pediatric Cancers estimated that 11% of all cancers in patients younger than 20 years could be categorized as very rare. This consensus group defined very rare cancers as those with annual incidences of fewer than two cases per 1 million people. However, three additional histologies (thyroid carcinoma, melanoma, and testicular cancer) with incidences of more than two cases per 1 million people were also included in the very rare group due to a lack of knowledge and expertise in the management of these tumors.[<a class="bibr" href="#CDR0000800111_rl_1864_9" rid="CDR0000800111_rl_1864_9">9</a>]</div></li><li class="half_rhythm"><div class="half_rhythm">The Children's Oncology Group defines rare pediatric cancers as those listed in the International Classification of Childhood Cancer subgroup XI, which includes thyroid cancers, melanomas and nonmelanoma skin cancers, and multiple types of carcinomas (e.g., adrenocortical carcinomas, nasopharyngeal carcinomas, and most adult-type carcinomas such as breast cancers and colorectal cancers).[<a class="bibr" href="#CDR0000800111_rl_1864_10" rid="CDR0000800111_rl_1864_10">10</a>] These diagnoses account for about 5% of the cancers diagnosed in children aged 0 to 14 years and about 27% of the cancers diagnosed in adolescents aged 15 to 19 years.[<a class="bibr" href="#CDR0000800111_rl_1864_4" rid="CDR0000800111_rl_1864_4">4</a>]</div><div class="half_rhythm"> Most cancers in subgroup XI are either melanomas or thyroid cancers, with other cancer types accounting for only 2% of the cancers diagnosed in children aged 0 to 14 years and 9.3% of the cancers diagnosed in adolescents aged 15 to 19 years.</div></li></ul><p id="CDR0000800111__1864_md_12">These rare cancers are extremely challenging to study because of the relatively few patients with any individual diagnosis, the predominance of rare cancers in the adolescent population, and the small number of clinical trials for adolescents with rare cancers.</p><p id="CDR0000800111__1837">Information about these tumors may also be found in sources relevant to
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adults with cancer, such as <a href="/books/n/pdqcis/CDR0000062916/?report=reader">Intraocular (Uveal) Melanoma Treatment</a>.</p><div id="CDR0000800111_rl_1864"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000800111_rl_1864_1">Smith MA, Seibel NL, Altekruse SF, et al.: Outcomes for children and adolescents with cancer: challenges for the twenty-first century. J Clin Oncol 28 (15): 2625-34, 2010. [<a href="/pmc/articles/PMC2881732/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2881732</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20404250" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20404250</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_1864_2">American Academy of Pediatrics: Standards for pediatric cancer centers. Pediatrics 134 (2): 410-4, 2014. <a href="https://pediatrics.aappublications.org/content/134/2/410" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Also available online</a>. Last accessed August 23, 2024.</div></li><li><div class="bk_ref" id="CDR0000800111_rl_1864_3">Smith MA, Altekruse SF, Adamson PC, et al.: Declining childhood and adolescent cancer mortality. Cancer 120 (16): 2497-506, 2014. [<a href="/pmc/articles/PMC4136455/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4136455</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24853691" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24853691</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_1864_4">National Cancer Institute: NCCR*Explorer: An interactive website for NCCR cancer statistics. Bethesda, MD: National Cancer Institute. <a href="https://NCCRExplorer.ccdi.cancer.gov/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed August 23, 2024.</div></li><li><div class="bk_ref" id="CDR0000800111_rl_1864_5">Surveillance Research Program, National Cancer Institute: SEER*Explorer: An interactive website for SEER cancer statistics. Bethesda, MD: National Cancer Institute. <a href="https://seer.cancer.gov/statistics-network/explorer/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed December 30, 2024.</div></li><li><div class="bk_ref" id="CDR0000800111_rl_1864_6">Ward E, DeSantis C, Robbins A, et al.: Childhood and adolescent cancer statistics, 2014. CA Cancer J Clin 64 (2): 83-103, 2014 Mar-Apr. [<a href="https://pubmed.ncbi.nlm.nih.gov/24488779" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24488779</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_1864_7">Gatta G, Capocaccia R, Botta L, et al.: Burden and centralised treatment in Europe of rare tumours: results of RARECAREnet-a population-based study. Lancet Oncol 18 (8): 1022-1039, 2017. [<a href="https://pubmed.ncbi.nlm.nih.gov/28687376" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28687376</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_1864_8">DeSantis CE, Kramer JL, Jemal A: The burden of rare cancers in the United States. CA Cancer J Clin 67 (4): 261-272, 2017. [<a href="https://pubmed.ncbi.nlm.nih.gov/28542893" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28542893</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_1864_9">Ferrari A, Brecht IB, Gatta G, et al.: Defining and listing very rare cancers of paediatric age: consensus of the Joint Action on Rare Cancers in cooperation with the European Cooperative Study Group for Pediatric Rare Tumors. Eur J Cancer 110: 120-126, 2019. [<a href="https://pubmed.ncbi.nlm.nih.gov/30785015" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30785015</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_1864_10">Pappo AS, Krailo M, Chen Z, et al.: Infrequent tumor initiative of the Children's Oncology Group: initial lessons learned and their impact on future plans. J Clin Oncol 28 (33): 5011-6, 2010. [<a href="/pmc/articles/PMC3020699/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3020699</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20956621" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20956621</span></a>]</div></li></ol></div></div><div id="CDR0000800111__1616"><h2 id="_CDR0000800111__1616_">Treatment and Outcome of Childhood Intraocular (Uveal) Melanoma</h2><p id="CDR0000800111__2290">Treatment options for childhood intraocular (uveal) melanoma include the following:</p><ol id="CDR0000800111__2291"><li class="half_rhythm"><div>Surgery.</div></li><li class="half_rhythm"><div>Radiation therapy.</div></li><li class="half_rhythm"><div>Laser surgery.[<a class="bibr" href="#CDR0000800111_rl_1616_1" rid="CDR0000800111_rl_1616_1">1</a>,<a class="bibr" href="#CDR0000800111_rl_1616_2" rid="CDR0000800111_rl_1616_2">2</a>]</div></li><li class="half_rhythm"><div>Bispecific fusion proteins (tebentafusp).</div></li></ol><p id="CDR0000800111__2413">A retrospective single-institution review identified 18 patients younger than 21 years with uveal melanoma.[<a class="bibr" href="#CDR0000800111_rl_1616_3" rid="CDR0000800111_rl_1616_3">3</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000810035/" class="def">Level of evidence C1</a>] Patients were treated with enucleation (n = 9), transscleral en bloc resection (n = 3), plaque radiation therapy (n = 5), or proton-beam radiation therapy (n = 1).</p><ul id="CDR0000800111__2462"><li class="half_rhythm"><div>Eight of these patients (44%) developed metastatic disease, all of whom died of their disease. The median survival time after detection of metastasis was 2.3 months (95% confidence interval [CI], 0.0–5.2 months).</div></li><li class="half_rhythm"><div>The median overall survival (OS) of the 18 patients after treatment of the primary intraocular tumors was 11.9 years (95% CI, 7.3–16.5 years). </div></li></ul><p id="CDR0000800111__2464">Laser surgery has been used to treat childhood intraocular melanoma.[<a class="bibr" href="#CDR0000800111_rl_1616_1" rid="CDR0000800111_rl_1616_1">1</a>,<a class="bibr" href="#CDR0000800111_rl_1616_2" rid="CDR0000800111_rl_1616_2">2</a>]</p><p id="CDR0000800111__2414">An open-label, randomized, phase III trial of adult patients with previously untreated HLA-A*02:01–positive metastatic uveal melanoma investigated treatment with tebentafusp. Tebentafusp is a bispecific restricted T-cell receptor for the glycoprotein 100 peptide; it is fused to a CD3 single-chain variable fragment. Patients were randomly assigned to receive either tebentafusp or treatment according to the investigator's choice.[<a class="bibr" href="#CDR0000800111_rl_1616_4" rid="CDR0000800111_rl_1616_4">4</a>]</p><ul id="CDR0000800111__2463"><li class="half_rhythm"><div> Patients who received tebentafusp had an OS rate of 73%, compared with 50% for patients in the control group (hazard ratio [HR] for death, 0.51; <i>P</i> < .001).</div></li><li class="half_rhythm"><div> The progression-free survival rate was also significantly higher for the tebentafusp group (31% vs. 16% at 6 months; HR for progression or death, 0.71; <i>P</i> = .01).</div></li><li class="half_rhythm"><div> The most common toxicities for patients who received tebentafusp were cytokine release syndrome, mostly grades 1 and 2, and rash.</div></li></ul><p id="CDR0000800111__1617">For information about the treatment of uveal melanoma in adults, see <a href="/books/n/pdqcis/CDR0000062916/?report=reader">Intraocular (Uveal) Melanoma Treatment</a>.</p><div id="CDR0000800111_rl_1616"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000800111_rl_1616_1">Al-Jamal RT, Cassoux N, Desjardins L, et al.: The Pediatric Choroidal and Ciliary Body Melanoma Study: A Survey by the European Ophthalmic Oncology Group. Ophthalmology 123 (4): 898-907, 2016. [<a href="https://pubmed.ncbi.nlm.nih.gov/26854035" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26854035</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_1616_2">Shields CL, Kaliki S, Arepalli S, et al.: Uveal melanoma in children and teenagers. Saudi J Ophthalmol 27 (3): 197-201, 2013. [<a href="/pmc/articles/PMC3770213/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3770213</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24227986" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24227986</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_1616_3">Fry MV, Augsburger JJ, Corrêa ZM: Clinical Features, Metastasis, and Survival in Patients Younger Than 21 Years With Posterior Uveal Melanoma. JAMA Ophthalmol 137 (1): 75-81, 2019. [<a href="/pmc/articles/PMC6439783/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6439783</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30422230" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30422230</span></a>]</div></li><li><div class="bk_ref" id="CDR0000800111_rl_1616_4">Nathan P, Hassel JC, Rutkowski P, et al.: Overall Survival Benefit with Tebentafusp in Metastatic Uveal Melanoma. N Engl J Med 385 (13): 1196-1206, 2021. [<a href="https://pubmed.ncbi.nlm.nih.gov/34551229" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34551229</span></a>]</div></li></ol></div></div><div id="CDR0000800111__2003"><h2 id="_CDR0000800111__2003_">Treatment Options Under Clinical Evaluation for Childhood Intraocular (Uveal) Melanoma</h2><p id="CDR0000800111__2004">Information about National Cancer Institute (NCI)–supported clinical trials can be found on the <a href="https://www.cancer.gov/research/participate/clinical-trials-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>. For information about clinical trials sponsored by other organizations, see the <a href="https://clinicaltrials.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ClinicalTrials.gov website</a>.</p></div><div id="CDR0000800111__2408"><h2 id="_CDR0000800111__2408_">Latest Updates to This Summary (08/13/2024)</h2><p id="CDR0000800111__2409">The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.</p><p id="CDR0000800111__2473">This summary was comprehensively reviewed.</p><p id="CDR0000800111__disclaimerHP_3">This summary is written and maintained by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/pediatric-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Pediatric Treatment Editorial Board</a>, which is
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editorially independent of NCI. The summary reflects an independent review of
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the literature and does not represent a policy statement of NCI or NIH. More
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information about summary policies and the role of the PDQ Editorial Boards in
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maintaining the PDQ summaries can be found on the <a href="#CDR0000800111__AboutThis_1">About This PDQ Summary</a> and <a href="https://www.cancer.gov/publications/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ® Cancer Information for Health Professionals</a> pages.
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</p></div><div id="CDR0000800111__AboutThis_1"><h2 id="_CDR0000800111__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000800111__AboutThis_2"><h3>Purpose of This Summary</h3><p id="CDR0000800111__AboutThis_3">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of pediatric intraocular (uveal) melanoma. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions.</p></div><div id="CDR0000800111__AboutThis_4"><h3>Reviewers and Updates</h3><p id="CDR0000800111__AboutThis_5">This summary is reviewed regularly and updated as necessary by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/pediatric-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Pediatric Treatment Editorial Board</a>, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p><p id="CDR0000800111__AboutThis_22"> Board members review recently published articles each month to determine whether an article should:</p><ul id="CDR0000800111__AboutThis_6"><li class="half_rhythm"><div>be discussed at a meeting,</div></li><li class="half_rhythm"><div>be cited with text, or</div></li><li class="half_rhythm"><div>replace or update an existing article that is already cited.</div></li></ul><p id="CDR0000800111__AboutThis_7">Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.</p><p>The lead reviewers for Childhood Intraocular (Uveal) Melanoma Treatment are:</p><ul><li class="half_rhythm"><div>Denise Adams, MD (Children's Hospital Boston)</div></li><li class="half_rhythm"><div>Karen J. Marcus, MD, FACR (Dana-Farber of Boston Children's Cancer Center and Blood Disorders Harvard Medical School)</div></li><li class="half_rhythm"><div>William H. Meyer, MD</div></li><li class="half_rhythm"><div>Paul A. Meyers, MD (Memorial Sloan-Kettering Cancer Center)</div></li><li class="half_rhythm"><div>Thomas A. Olson, MD (Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta - Egleston Campus)</div></li><li class="half_rhythm"><div>Alberto S. Pappo, MD (St. Jude Children's Research Hospital)</div></li><li class="half_rhythm"><div>Arthur Kim Ritchey, MD (Children's Hospital of Pittsburgh of UPMC)</div></li><li class="half_rhythm"><div>Carlos Rodriguez-Galindo, MD (St. Jude Children's Research Hospital)</div></li><li class="half_rhythm"><div>Stephen J. Shochat, MD (St. Jude Children's Research Hospital)</div></li></ul><p id="CDR0000800111__AboutThis_9">Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.</p></div><div id="CDR0000800111__AboutThis_10"><h3>Levels of Evidence</h3><p id="CDR0000800111__AboutThis_11">Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Pediatric Treatment Editorial Board uses a <a href="/books/n/pdqcis/CDR0000062796/?report=reader">formal evidence ranking system</a> in developing its level-of-evidence designations.</p></div><div id="CDR0000800111__AboutThis_12"><h3>Permission to Use This Summary</h3><p id="CDR0000800111__AboutThis_13">PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].”</p><p id="CDR0000800111__AboutThis_14">The preferred citation for this PDQ summary is:</p><p id="CDR0000800111__AboutThis_15">PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Intraocular (Uveal) Melanoma Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/eye/hp/child-intraocular-melanoma-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/eye/hp/child-intraocular-melanoma-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 31909938]</p><p id="CDR0000800111__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>, a collection of over 2,000 scientific images.
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</p></div><div id="CDR0000800111__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000800111__AboutThis_18">Based on the strength of the available evidence, treatment options may be described as either “standard” or “under clinical evaluation.” These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000800111__AboutThis_20"><h3>Contact Us</h3><p id="CDR0000800111__AboutThis_21">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>.</p></div></div></div></div><div class="fm-sec"><h2 id="_NBK552282_pubdet_">Publication Details</h2><h3>Author Information and Affiliations</h3><p class="contrib-group"><h4>Authors</h4><span itemprop="author">PDQ Pediatric Treatment Editorial Board</span>.</p><h3>Publication History</h3><p class="small">Published online: August 13, 2024.</p><p class="small">Created: <span itemprop="datePublished">December 23, 2019</span>.</p><h3>Version History</h3><ul class="simple-list" style="padding:0"><li><span class="bk_col_itm">NBK552282.11</span> August 13, 2024 (Displayed Version)</li><li><span class="bk_col_itm"><a href="/books/NBK552282.10/?report=reader">NBK552282.10</a></span> April 11, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK552282.9/?report=reader">NBK552282.9</a></span> January 3, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK552282.8/?report=reader">NBK552282.8</a></span> January 13, 2023</li><li><span class="bk_col_itm"><a href="/books/NBK552282.7/?report=reader">NBK552282.7</a></span> December 13, 2022</li><li><span class="bk_col_itm"><a href="/books/NBK552282.6/?report=reader">NBK552282.6</a></span> February 25, 2022</li><li><span class="bk_col_itm"><a href="/books/NBK552282.5/?report=reader">NBK552282.5</a></span> December 17, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK552282.4/?report=reader">NBK552282.4</a></span> October 6, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK552282.3/?report=reader">NBK552282.3</a></span> June 8, 2020</li><li><span class="bk_col_itm"><a href="/books/NBK552282.2/?report=reader">NBK552282.2</a></span> January 31, 2020</li><li><span class="bk_col_itm"><a href="/books/NBK552282.1/?report=reader">NBK552282.1</a></span> December 23, 2019</li></ul><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div></div><h3>Publisher</h3><p><a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>, Bethesda (MD)</p><h3>NLM Citation</h3><p>PDQ Pediatric Treatment Editorial Board. Childhood Intraocular (Uveal) Melanoma Treatment (PDQ®): Health Professional Version. 2024 Aug 13. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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