Paediatric uveal melanoma in Ireland 2010 - 2024: incidence, clinical features, management, and outcomes.
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BACKGROUND: Uveal melanoma is predominantly an adult malignancy, with Ireland reporting one of the highest incidence rates at 9.5 cases per million adults annually. Paediatric uveal melanoma is extremely rare, accounting for fewer than 1% to 2% of all uveal melanoma cases in published series. METHODS: This retrospective study included all patients under 18 years of age diagnosed with uveal melanoma in Ireland between 2010 and 2024. Data were collected from medical records and included demographics, tumour location and dimensions, histopathology or cytology (where available), presence of metastasis, treatment modality, baseline and final visual acuity, intraocular pressure, and survival outcomes. RESULTS: Six Caucasian patients (five male, one female), aged 6 to 17 years, were identified. Tumour locations included five choroidal and one ciliochoroidal melanoma. Treatment modalities included enucleation (n = 2), plaque brachytherapy (two Ruthenium-106, one Iodine-125), and proton beam radiotherapy (n = 1). Histopathological analysis was available in two cases, revealing one mixed cell type and one spindle B melanoma. Fine needle aspiration biopsy was performed in two patients. Mean follow-up was 30 months (median 24; range 12-178). All cases remained metastasis-free at last follow-up. CONCLUSIONS: This national case series highlights the rarity and clinical relevance of paediatric uveal melanoma. Outcomes have been favourable, but recent case clustering supports the need for international comparative data collection. Early diagnosis and appropriate treatment help preserve vision and reduce morbidity. Molecular profiling, where possible, may guide metastatic risk assessment. Further studies are needed to confirm international incidence trends.