Purpose: To identify the incidence and mortality of ocular melanoma in New Zealand. Method: Data for all cases of primary ocular melanoma diagnosed from 1 January 2000 to 31 December 2020 were collected retrospectively from the New Zealand Cancer Registry and Auckland District Health Board clinical records. Results: A total of 1085 cases of ocular melanoma were identified. 72.7 involved the choroid, followed by 12.6 ciliary body, 7.0 conjunctival, 3.0 iris and 4.7 were of other, multiple or unspecified sites. The crude annual incidence of ocular melanoma was 12.4 cases/million. Fifty-one percent were female. The median age at diagnosis was 65.08 years (interquartile range IQR 55.06-74.7). Ninety-five percent were New Zealand European, followed by 4 Maori and Pacific Island, and 1 Asian. Notably, 45 of patients were deceased (all-cause) at a median follow-up of 5.18 years (IQR 2.28-9.65). The median age at death was 75.2 years (IQR 65.9-84.1) and the median time to death from diagnosis was 3.3 years (IQR 1.8 to 6.3). 74.4 (N = 791) of cases were histologically confirmed - at initial presentation, 56 had localised disease, 6 had invasion of adjacent tissue, 4 had distant metastases and 35 were not known. Conclusions: New Zealand has one of the highest documented incidences of ocular melanoma and the proportion of ciliary body melanoma is approximately twice as high when compared to international studies. Systemic prognosis is guarded with an overall mortality of 45. Further research is required to identify the role of ultraviolet light in the development of ocular melanoma in New Zealand.
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