Virtual screening for uveal melanoma: A Princess Margaret cancer centre perspective during the COVID-19 pandemic

ABSTRACT

Princess Margaret Cancer Centre (PM) receives roughly 120 new patients (pts) per year with uveal melanoma (UM). Moderate to high-risk pts, based on AJCC staging and cytogenetics, undergo a strict surveillance program for metastases with liver MRI every 4-6 months and annual chest imaging. The importance of surveillance has been highlighted by new therapies which are likely more effective in pts with lower volume metastases. In this single center retrospective study, we assessed the effectiveness of a virtual surveillance model, by comparing UM pts on standard in-person surveillance (SS) pre-COVID (August 2018 to March 2020) with virtual surveillance (VS) after COVID onset (April 2020 to November 2021). Virtual visits were done through phone or MS Teams video calls, and images were done either locally or externally. We identified 106 pts who underwent SS and 107 pts who underwent VS. In the SS group, 10 pts were diagnosed with metastasis and of these 9 (90%) were staged as M1a disease and 1 (10%) was M1b. In the VS group, 20 pts were diagnosed with metastases, 2 (10%) of which had M1b disease and 18 (90%) with M1a disease. Fifteen (14%) pts in the SS group and 34 (20%) pts in the VS group lived out of province;13 (12%) of the SS pts and 36 (21%) of pts in the VS cohort had scans externally. With regards to surveillance adherence in the SS group, 70 (66%) of pts had their scans performed on time versus 127 (75%) of pts in the VS cohort. Virtual screening of pts with moderate to high-risk UM during the COVID 19 pandemic showed similar ability to detect low volume disease compared with our standard screening. There was a higher level of adherence to screening during the VS period. When implemented appropriately, VS appears to be an effective model to monitor UM pts.