Table of Contents
1
UI - 11917800
AU - Groh MJ; Kuchle M; Naumann GO
TI -
[Corneal neural paralysis after block excision including the 3 and 9
o'clock meridian]
SO - Ophthalmologe 2002 Mar;99(3):181-2
AD - Augenklinik mit Poliklinik, Universitat Erlangen-Nurnberg,
Schwabachanlage 6, 91054 Erlangen.
michael.groh@augen.imed.uni-erlangen.de
PURPOSE: Corneal innervation is mainly supported by the long posterior
ciliary nerves. Anatomically, the long ciliary nerves run with the long
ciliary arteries at 3 and 9 o'clock. The aim of this retrospective study
was to find out if block excision of anterior uveal tumors or epithelial
ingrowth located at the 3 or 9 o'clock position of the limbal
circumference causes corneal neuroparalysis. PATIENTS AND METHODS:
in our department (92 block excisions because of anterior uveal tumors
and 59 because of cystic epithelial ingrowth to the anterior chamber).
In 27 patients, anterior uveal tumors or cystic epithelial ingrowth were
located at the 3 or 9 o'clock position of the limbal circumference (14
patients with cystic epithelial ingrowth and 13 patients with anterior
uveal tumors). Mean age of all patients was 54.4 +/- 15.7 years at the
time of surgery. Mean diameter of the block excision was 10.7 +/- 4.5 mm
for tumor-patients and 9.0 +/- 1.2 mm for patients with anterior chamber
cysts. Mean follow-up time was 93.6 +/- 43 months. RESULTS: Only 1 of 27
patients exhibited a moderate neuroparalytic corneal ulcer during the
follow-up time. In the remaining 26 patients, no signs of clinically
relevant corneal neuroparalysis such as epithelial disorders or
neuroparalytic ulcers were found. CONCLUSION: Block excision of tumors
or cystic epithelial ingrowth located at the 3 or 9 o'clock position of
the limbal circumference did not lead to severe neuroparalytic disorders
of the host cornea. This may be an important factor in postoperative
management of patients undergoing block excision and corneoscleral
grafting.
2
UI - 11917803
AU - Mueller AJ; Freeman WR; Folberg R; Schaller UC; Kampik A
TI -
[The Munich/San Diego/Iowa City Collaboration (MuSIC). MuSIC Report I:
Design , characteristics of the collective and preliminary results]
SO - Ophthalmologe 2002 Mar;99(3):193-9
AD - Augenklinik der Ludwig-Maximilians-Universitat, Mathildenstrasse 8,
80336 Munchen.
BACKGROUND: We have previously shown that histologically described
microcirculation patterns (MCP) can be visualized with indocyanine green
(ICG) angiography. We have designed a prospective study to evaluate the
prognostic value of these angiographically imaged MCP in small choroidal
melanocytic lesions. In this report we describe the design of the study,
characterize the patient collective, and present the first results.
PATIENTS AND METHODS: In this prospective nonrandomized observational
study, unilateral choroidal melanocytic lesions with 1.5-5.5 mm maximum
apical height are observed until growth is determined according to
defined criteria. Variables are demographic parameters, subjective
symptoms, subretinal fluid, location and dimension of tumor, hemorrhage,
color, orange pigment, and MCP determined by ICG angiography: normal,
straight, parallel without crosslinking, parallel with crosslinking,
arcs without branching, arcs with branching, loop, and network. RESULTS:
Seventy patients (22 males, 48 females; age: 33-88 years, median: 64
years) have been included up to now: 19 tumors showed growth so far
(time to growth: 51-946 days, median: 127 days). The following
parameters were statistically significantly correlated with time to
tumor growth: flashes (p = 0.082), orange pigment (p = 0.012),
subretinal fluid (p < 0.001), maximum basal tumor diameter (p = 0.001),
maximum apical tumor height (p < 0.001), parallel with crosslinking (p <
0.001), arcs with branching (p = 0.006), loop (p < 0.001), and network
(p < 0.001). Of these, complex MCP (parallel with crosslinking, arcs
with branching, loop and/or network) showed the strongest correlation
with time to tumor growth in a Cox regression model. Based on our data,
the positive predictive value of imaging complex MCP (for growth within
12 months) is 78% and the negative predictive value is 98%. CONCLUSION:
Our patient collective demonstrates comparable prognostic parameters for
time to growth as described in the literature. In addition, the ICG
angiographic detection of complex MCP is more strongly predictive of the
time to growth than other clinically determinable factors. Thus, we
recommend this examination for patients with small choroidal melanocytic
lesions, if the patient is to be counseled regarding the likely biologic
behavior of his tumor.
3
UI - 11766025
AU - Esmaeli B; Eicher S; Popp J; Delpassand E; Prieto VG; Gershenwald JE
TI -
Sentinel lymph node biopsy for conjunctival melanoma.
SO - Ophthal Plast Reconstr Surg 2001 Nov;17(6):436-42
AD - Department of Plastic Surgery, The University of Texas M. D. Anderson
Cancer Center, Houston 77030, USA.
OBJECTIVE: To investigate the feasibility and safety of preoperative
lymphoscintigraphy and sentinel lymph node (SLN) biopsy for conjunctival
melanoma. METHODS: A 49-year-old man with a biopsy-proven malignant
melanoma of the conjunctiva (caruncle) underwent preoperative
lymphoscintigraphy and SLN biopsy using a technique in which both
isosulfan blue dye and technetium Tc 99 m sulfur colloid were injected
in the subconjunctival space around the primary lesion. The conjunctival
melanoma was excised just before identification and removal of the SLNs.
The SLNs were excised along with concomitant dissection of their
associated lymph node basins. The SLNs were evaluated histologically
using serial sectioning and immunohistochemical staining with antisera
against the S-100 protein and the melanoma antigen HMB-45. RESULTS:
Three SLNs were identified in the left submandibular and the left upper
and middle jugular lymph node basins during the preoperative
lymphoscintigraphy. The same three SLNs were successfully identified in
the operating room. The SLNs were histologically negative, and the
immunohistochemical staining against S-100 and HMB-45 was also negative.
We did not observe any immediate adverse effects on the globe or the
periocular structures from lymphatic mapping and SLN biopsy. By 24 hours
after injection of blue dye, only a faint trace of blue was visible on
the ocular surface. CONCLUSIONS: Preoperative lymphoscintigraphy and SLN
biopsy can be performed safely in patients with conjunctival melanoma. A
larger study is planned to determine the sensitivity of this technique
for the detection of occult regional nodal disease in patients with
conjunctival melanoma.
4
UI - 11794392
AU - Peyman GA; Cheema RA; Lagouros PA
TI -
Endoresection of a ciliochoroidal melanoma.
SO - Can J Ophthalmol 2001 Dec;36(7):411-4; discussion 414-5
AD - Department of Ophthalmology, School of Medicine, Tulane University
Health Sciences Center, New Orleans, LA 70112-2699, USA.
5
UI - 11955750
AU - Hermann RM; Pradier O; Lauritzen K; Ott M; Schmidberger H; Hess CF
TI -
Does escalation of the apical dose change treatment outcome in
beta-radiation of posterior choroidal melanomas with 106Ru plaques?
SO - Int J Radiat Oncol Biol Phys 2002 Apr 1;52(5):1360-6
AD - Department of Radiotherapy and Radiooncology, University of Goettingen,
Goettingen, Germany. ro.hermann@t-online.de
PURPOSE: To show the results of treating posterior uveal melanomas with
106Ru plaque beta-ray radiotherapy and to review and discuss the
literature concerning the optimal apical dose prescription (100 vs. 160
Gy). METHODS AND MATERIALS: Forty-eight patients with uveal melanomas
(median height 3.85 mm + 1 mm sclera) were treated with ruthenium
plaques. The median apical dose was 120 Gy, the median scleral dose 546
Gy. RESULTS: After 5.8 years of follow-up, the overall 5-year survival
rate was 90%, the disease specific 5-year survival rate was 92% (3
patients alive with metastasis). Six percent received a second ruthenium
application, 10% of the eyes had to be enucleated. Local control was
achieved in 90% of the patients with conservative therapy alone. Central
or paracentral tumors showed 50% of the pretherapeutic vision after 4
years, and 80% of the vision was preserved in those with peripheral
tumors. The main side effects were mostly an uncomplicated retinopathy
(30%); macular degeneration or scarring led to poor central vision in
30% of cases. CONCLUSION: Brachytherapy with ruthenium applicators is an
effective therapy for small- and medium-size posterior uveal melanomas.
Our results are comparable to other series. The treatment outcome does
not seem to be capable of improvement by increasing the apical dose. An
internationally accepted model for defining the dosage in brachytherapy
is needed.
6
UI - 11292427
AU - Demirci H; Shields CL; Shields JA; Eagle RC Jr; Honavar SG
TI -
Bilateral breast metastases from choroidal melanoma.
SO - Am J Ophthalmol 2001 Apr;131(4):521-3
AD - Oncology Service, Wills Eye Hospital, Thomas Jefferson University,
Philadelphia, Pennsylvania 19107, USA.
PURPOSE: To report an unusual case of solitary sequential bilateral
breast metastases from choroidal melanoma. METHOD: Case report. RESULTS:
A 48-year-old woman with a large choroidal melanoma in the left eye was
treated with Iodine-125 brachytherapy and responded satisfactorily with
decrease in tumor thickness. Thirty-seven months after treatment, she
developed a solitary, circumscribed melanoma metastasis to the right
breast, and 54 months after treatment, a similar metastasis was detected
in her left breast. Both breast tumors were managed with lumpectomy.
Systemic examination including magnetic resonance imaging of abdomen,
chest, and head have been performed regularly and have been normal. At
61 months after treatment, the patient has no clinical evidence of
metastatic disease elsewhere. CONCLUSIONS: Uveal melanoma rarely
metastasizes to breast tissue. A breast nodule in a patient with a
history of uveal melanoma is most likely a primary breast tumor but may
rarely represent a metastasis from uveal melanoma.
7
UI - 11730680
AU - McCormick A; Rennie I
TI -
Bilateral breast metastases from choroidal melanoma.
SO - Am J Ophthalmol 2001 Dec;132(6):951-2
8
UI - 11904462
AU - Cartsburg O; Kallen C; Hillenkamp J; Sundmacher R; Pomjanski N; Bocking
TI -
A
Topical mitomycin C and radiation induce conjunctival DNA-polyploidy.
SO - Anal Cell Pathol 2001;23(2):65-74
AD - Department of Ophthalmology, Heinrich-Heine University, Dusseldorf,
Germany. cartsbur@uni-duesseldorf.de
INTRODUCTION: Atypical cell changes often occur following treatment of
premalignant or malignant conjunctival neoplasias with topical mitomycin
C (MMC) and/or radiation. These reactive, non-neoplastic alterations of
the conjunctival epithelium can be a differential diagnostic problem.
Our aim was to investigate changes in the nuclear DNA-distribution of
conjunctival epithelial cells after MMC- and radiation therapy by
DNA-image-cytometry. METHODS: Conjunctival brush smears were obtained
from 13 patients (13 eyes) with squamous cell carcinomas and six
patients (6 eyes) with conjunctival malignant melanomas in situ before,
during and after treatment. The patients were treated with MMC-drops
(0.02% or 0.04%) alone (n=12), with radiation therapy (n=3) or both
(n=4). At first, the obtained brush smears were evaluated by cytology.
Secondly, after Feulgen restaining, the DNA content of reactively
changed cells was determined using the AutoCyte-QUIC-DNA workstation.
RESULTS: We observed euploid DNA-polyploidy and cytomorphological
changes in all patients (19/19). We considered these alterations as
reactive to treatment. Four patients showed their greatest DNA-stemline
at 4c and 15 patients at 8c. This effect was observed during and
following MMC-drops and/or radiation and remained stable in 94% of all
patients after a mean follow-up of 22.5 months (SD 15.4). In five cases
image cytometry additionally demonstrated DNA-stemline aneuploidy as an
evidence of tumor recurrence. CONCLUSION: Measurements of DNA-content
revealed euploid polyploidisation of morphological suspicious but benign
squamous cells which is the biologic correlate of well known secondary
morphologic changes following topical chemotherapy and/or radiation.
DNA-image-cytometry is a useful tool in the differention of euploid
polyploidization as a sign of reactive cell changes following treatment
and tumor recurrences.
9
UI - 11986095
AU - Vaziri M; Buffam FV; Martinka M; Oryschak A; Dhaliwal H; White VA
TI -
Clinicopathologic features and behavior of cutaneous eyelid melanoma.
SO - Ophthalmology 2002 May;109(5):901-8
AD - Department of Pathology, Vancouver General Hospital and University of
British Columbia, Vancouver, British Columbia, Canada.
OBJECTIVE: To study the clinical and histopathologic features of
cutaneous eyelid melanomas and identify prognostic factors in the
behavior of such tumors. DESIGN: Retrospective observational case
series. PARTICIPANTS: Twenty-three patients with cutaneous eyelid
melanomas without conjunctival involvement. METHODS: Patients' charts
were reviewed for clinical information, treatment procedure, and disease
course (updated at the time of study). Histopathologic sections from all
surgical procedures were reviewed. MAIN OUTCOME MEASURES: Histologic
type of melanoma, tumor growth phase, Clark's level of invasion, tumor
thickness, and other microscopic features were evaluated in each case.
The width of excision margins was considered and measured histologically
when possible. RESULTS: There was no gender predilection. The lower
eyelid was more frequently involved than the upper eyelid or canthi.
Seventeen cases (74%) were invasive, and six (26%) were in situ
melanomas. Lentigo maligna melanoma was the most common histologic type,
accounting for 61% (14 cases) of all melanomas and 53% (9 cases) of
invasive melanomas. Superficial spreading melanoma accounted for 22% (5
cases) and nodular melanoma for 17% (4 cases) of all melanomas. Surgical
excision, as the treatment of choice, was incomplete in nine cases, two
thirds of which were lentigo maligna melanoma (in situ or invasive).
Tumor reappeared in 77.8% of these cases. Fourteen patients had initial
narrow excisions, and three of them (21.4%) had local recurrences.
Although recurrence occurred in one each of our "in situ," "thin," and
"thick" melanomas, it proceeded to distant metastases and death only in
the "thin" one. Adjuvant radiotherapy was used in six patients with
successful disease control in two cases. CONCLUSIONS: Eyelid skin
melanomas have a relatively good clinical prognosis. The histologic type
and thickness of the primary melanoma were not clearly related to the
clinical behavior once they were completely excised. The use of very
narrow excisions of 5 mm or less was associated with greater frequency
of local recurrence. Lentigo maligna melanomas were the largest tumors
at presentation and, despite being thinner, were a greater surgical
challenge. This type of melanoma is almost certainly underdiagnosed by
ophthalmologists.
10
UI - 11986096
AU - Haas A; Pinter O; Papaefthymiou G; Weger M; Berghold A; Schrottner O;
TI -
Mullner K; Pendl G; Langmann G
Incidence of radiation retinopathy after high-dosage single-fraction
gamma knife radiosurgery for choroidal melanoma.
SO - Ophthalmology 2002 May;109(5):909-13
AD - Department of Ophthalmology, Karl-Franzens University, Graz, Austria.
OBJECTIVE: To investigate the incidence and clinical findings of
radiation retinopathy after single-fraction high-dose gamma knife
radiosurgery for choroidal melanoma. DESIGN: Retrospective
noncomparative interventional case series. PARTICIPANTS: Thirty-two
patients with choroidal melanoma. METHODS: Review of charts, color
fundus photographs, and fluorescein angiograms of 32 choroidal melanoma
patients after radiosurgery. All patients were treated with the Leksell
gamma knife in one fraction with a marginal dose between 40 and 80 Gy
(median, 50 Gy) and were followed for at least 24 months (or until
enucleation because of complications secondary to radiation). MAIN
OUTCOME MEASURES: Any clinical feature of radiation retinopathy and
neovascular glaucoma. RESULTS: During a mean follow-up of 38 months
(range, 6-81 months) we found radiation retinopathy in 84% of our
patients. The most common findings in these patients were intraretinal
hemorrhages with an incidence of 70%, macular edema and capillary
nonperfusion in 63%, and hard exudates in 52% of the patients. Less
common were microaneurysms in 30% and retinal neovascularization in 22%.
The time of onset of the various radiation-associated retinal findings
ranged between 1 and 22 months. Forty-seven percent of all patients
developed neovascular glaucoma. In our study there was no correlation
between radiation dosage applied and clinical findings. CONCLUSIONS:
Single-fraction high-dose Leksell gamma knife radiosurgery of choroidal
melanomas with a median marginal dose of 50 Gy is highly associated with
early radiation retinopathy and with neovascular glaucoma.
11
UI - 11986097
AU - Tuomaala S; Aine E; Saari KM; Kivela T
TI -
Corneally displaced malignant conjunctival melanomas.
SO - Ophthalmology 2002 May;109(5):914-9
AD - Ocular Oncology Service, Department of Ophthalmology, Helsinki
University Central Hospital, Helsinki, Finland.
PURPOSE: To characterize and classify malignant conjunctival melanomas
with exclusively corneal invasive growth. DESIGN: Population-based,
nationwide retrospective cross-sectional study. PARTICIPANTS: Patients
with primary malignant conjunctival melanoma diagnosed between 1967 and
2000 in Finland. METHODS: On the basis of all available clinical and
histopathologic data of tumors diagnosed during the study period,
malignant conjunctival melanomas that first demonstrated invasive growth
on the cornea without evidence of conjunctival tumors other than primary
acquired melanosis were identified, their prevalence calculated, and
their characteristics reviewed. On the basis of these cases and
literature data, a classification for "corneal melanoma" was developed.
MAIN OUTCOME MEASURES: Frequency and type of corneal involvement,
recurrence, and survival. RESULTS: Patients with exclusively corneal
invasive tumor accounted for 5% (95% confidence interval, 1-12) of 85
consecutive primary conjunctival melanomas. Two were separated from the
limbus by clear cornea (type I), and two paralleled but did not invade
the limbal conjunctiva (type II). Two were associated with clear
evidence of primary acquired melanosis. None of the tumors recurred
after local excision, and no metastases were observed during a median
follow-up of 2 years 5 months (range, 1 year 8 months-7 years 10
months). CONCLUSIONS: Primary malignant conjunctival melanomas can grow
on the cornea without conjunctival involvement other than acquired
melanosis. They are easily removed and do not cause lymphatic
metastases. The term "corneally displaced malignant conjunctival
melanoma" would best describe their supposed conjunctival origin and
actual corneal location.
12
UI - 11973396
AU - Sharma MC; Shields CL; Shields JA; Eagle RC Jr; Demirci H; Wiley L
TI -
Benign lymphoid infiltrate of the iris simulating a malignant melanoma.
SO - Cornea 2002 May;21(4):424-5
AD - Oncology Service, Wills Eye Hospital, Thomas Jefferson University,
Philadelphia, Pennsylvania 19107, USA.
PURPOSE: To report a clinicopathologic correlation of an unusual benign
lymphocytic iris mass in a patient who had no systemic
lymphoproliferative disease. METHODS: Case report. RESULTS: A
49-year-old man developed a circumscribed, tan lesion in his left iris.
The lesion was suspected clinically to be an atypical iris melanoma.
Histopathologic studies of the resected mass revealed a solid tumor that
was comprised of lymphocytes and histiocytes. Immunohistochemical
studies identified that most of the cells were T lymphocytes. The
histopathologic diagnosis was atypical lymphoid infiltrate. Workup for
systemic lymphoma and Epstein-Barr virus infection was negative.
CONCLUSION: Lymphoid infiltrate can manifest as a solitary mass that can
simulate an iris melanoma.
13
UI - 11906300
AU - Stoffelns BM
TI -
Primary transpupillary thermotherapy (TTT) for malignant choroidal
melanoma.
SO - Acta Ophthalmol Scand 2002 Feb;80(1):25-31
AD - Department of Ophthalmology, Johannes Gutenberg University Mainz,
Germany. stoffelns@augen.klinik.uni-mainz.de
PURPOSE: To evaluate the efficacy of transpupillary thermotherapy (TTT)
as the only method of treatment for small choroidal melanoma. PATIENTS
AND METHODS: In a prospective non-randomized analysis, 20 patients with
primary choroidal melanoma (posterior to the equator with base < or = 2
and thickness < or = 4.5 mm) were treated with TTT as the only method of
treatment (diode laser at 810 nm, beam diameter 3 mm, power setting
0.3-0.9 W, exposure time 20-37 min). During follow-up of at least 6
months, clinical aspects, ultrasonographic tumour thickness, fluorescein
and indocyanine green angiographic patterns, visual acuity and ocular
side-effects were recorded. RESULTS: In 17 eyes the tumour regressed
significantly within 3 months after one treatment session (to a flat
chorioretinal scar in 15 eyes). Despite a clinically flattened
chorioretinal scar, fluorescein and indocyanine green angiography
revealed that choriocapillary vessels in the heat-treated areas of 15
eyes remained perfused. Three amelanotic melanomas showed almost no
response to TTT after repeated treatment at higher power settings.
Visual acuity remained unchanged or improved in 12 eyes. Ocular
side-effects included posterior synechia of the iris (1), macular oedema
(2) and temporary retrobulbar pain (2). No patient showed tumour
recurrence or metastases during follow-up. CONCLUSIONS: Preliminary
results obtained by this study demonstrate good efficacy and visual
outcome following TTT as the only method of treatment for small
choroidal melanoma. However, indocyanine green angiographic findings
suggest that tissue damage in the choroidal layer might be less
effective, which perhaps may lead to a higher rate of tumour regrowth.
Long-term follow-up is required to obtain data on late ocular
side-effects, tumour recurrence and metastasis.
14
UI - 11914199
AU - Stitt AW; Gardiner TA
TI -
Anti-angiogenic therapy for uveal melanoma--more haste, less speed.
SO - Br J Ophthalmol 2002 Apr;86(4):368-9
15
UI - 11914215
AU - Boyd SR; Tan DS; de Souza L; Neale MH; Myatt NE; Alexander RA; Robb M;
TI -
Hungerford JL; Cree IA
Uveal melanomas express vascular endothelial growth factor and basic
fibroblast growth factor and support endothelial cell growth.
SO - Br J Ophthalmol 2002 Apr;86(4):440-7
AD - Department of Pathology, Institute of Ophthalmology, University College
London, Bath Street, London EC1V 9EL, UK.
BACKGROUND: Tumour microvascularity is a significant determinant of
prognosis for a large number of different tumours, including uveal
melanoma. The development of blood vessels within these and other
tumours is partly controlled by soluble pro-angiogenic cytokines, of
which basic fibroblast growth factor (bFGF) and vascular endothelial
growth factor-A (VEGF) are the best described. METHODS: Because VEGF has
been inconsistently found within uveal melanomas and bFGF is described
as an autocrine growth factor in cutaneous melanoma, the authors looked
at the expression of these cytokines in uveal melanomas using
immunohistochemistry and reverse transcriptase polymerase chain reaction
(RT-PCR). The cross talk between uveal melanoma cells and endothelial
cells was then assessed in an in vitro co-culture model. RESULTS: While
most tumour cells expressed bFGF at the protein level by
immunohistochemistry (89%), relatively few (22%) expressed VEGF, and
this was of limited extent. All 20 tumours tested by RT-PCR contained
mRNA for both bFGF and VEGF. Co-culture experiments using an ATP based
bioassay showed that uveal melanomas could support the growth of a rat
brain endothelial cell line (GPNT) and human umbilical vein endothelial
cells (HUVEC), and that this could be modulated by cytokines and
anti-cytokine antibodies. CONCLUSION: These results suggest that
angiogenesis within uveal melanoma may be the result of a complex
interplay between endothelial and tumour cells, and that bFGF and VEGF
could play a part.
16
UI - 11914216
AU - Boyd SR; Tan D; Bunce C; Gittos A; Neale MH; Hungerford JL;
TI -
Charnock-Jones S; Cree IA
Vascular endothelial growth factor is elevated in ocular fluids of eyes
harbouring uveal melanoma: identification of a potential therapeutic
window.
SO - Br J Ophthalmol 2002 Apr;86(4):448-52
AD - Department of Pathology, Institute of Ophthalmology, University College
London, Bath Street, London EC1V 9EL, UK.
BACKGROUND: Improved local treatment of uveal melanoma makes it possible
for many patients to retain the affected eye, but a proportion will
develop secondary complications such as neovascularisation of the iris
(NVI) and require enucleation. Although vascular endothelial growth
factor A (VEGF-A) is known to correlate with NVI and can cause NVI in
experimental models, this pro-angiogenic cytokine is consistently
reported to be absent in uveal melanoma. Novel anti-VEGF therapies are
now in clinical trial, and the authors therefore wished to determine
whether VEGF-A was indeed elevated in melanoma bearing eyes. METHODS:
VEGF-A concentrations were measured in aqueous and vitreous from 19 and
30 enucleated eyes respectively. RESULTS: Elevated VEGF-A concentrations
(up to 21.6 ng/ml) were found in melanoma bearing eyes compared with
samples from patients undergoing routine cataract extraction (all had
values below 0.96 ng/ml). Immunohistochemistry showed VEGF-A protein in
the iris and/or ciliary body of 54% and basic fibroblast growth factor
(bFGF) in 82% of the eyes examined. VEGF was found to a limited extent
and at very low levels in only 9% of these tumours. Aqueous or vitreous
VEGF levels showed no apparent correlation with retinal detachment,
tumour size, vascularity, or immunohistochemistry. Though limited in
number, the highest VEGF levels correlated with previous radiation
therapy, and with the presence neovascularisation of the iris or optic
nerve head. bFGF was not significantly elevated in ocular fluids: it is
known to be a pro-angiogenic agent and was detected in the majority of
primary uveal melanomas. CONCLUSION: Based on this study, though the
source of VEGF within eyes harbouring uveal melanoma is not clear, these
data suggest that anti-VEGF therapy might prove useful in the management
of some patients with NVI secondary to uveal melanoma.
17
UI - 11839674
AU - Naus NC; Verhoeven AC; van Drunen E; Slater R; Mooy CM; Paridaens DA;
TI -
Luyten GP; de Klein A
Detection of genetic prognostic markers in uveal melanoma biopsies using
fluorescence in situ hybridization.
SO - Clin Cancer Res 2002 Feb;8(2):534-9
AD - Department of Ophthalmology, Erasmus University Rotterdam, 3000 DR
Rotterdam, the Netherlands.
PURPOSE: In uveal melanoma, specific chromosomal abnormalities are known
to correlate with the risk of metastases; changes in chromosomes 3 and
8q correlate strongly with a decreased survival of the patient, whereas
chromosome 6 abnormalities are associated with a better prognosis.
Usually, karyotyping and fluorescence in situ hybridization (FISH)
analysis are used to detect these abnormalities in resected tumor
tissues. However, the evaluation of these chromosomal changes is
compromised in patients treated with eye-retaining treatment protocols
because of the lack of tumor material. The purpose of this study was to
validate the use of FISH for the analysis of genetic prognostic markers.
EXPERIMENTAL DESIGN: We analyzed 40 uveal melanoma fine needle
aspiration biopsies (FNABs) and the corresponding main tumor with FISH.
RESULTS: All biopsies were found to contain tumor cells, and FISH
analyses of the samples were successful in all cases. Statistical
analysis showed very good agreement between the FISH results from the
biopsies and those from the main tumor. In only 2 of 249 hybridizations
did we find a small variation that could have led to a
misclassification. CONCLUSIONS: Our results indicate that the
application of FISH to FNABs is a reliable method for assaying genetic
prognostic parameters such as chromosome 3 loss and/or chromosome 8q
gain. Implementation of this method in a diagnostic setting means that
we are able to identify patients at risk of developing metastatic
disease, not only in enucleated patients but also in cases treated with
conservative treatment modalities such as radiotherapy.
18
UI - 11928693
AU - Filik L; Oskay T; Ozyilkan O
TI -
Conjunctival involvement in a patient with cutaneous malignant melanoma.
SO - Onkologie 2002 Feb;25(1):64-5
19
UI - 11886408
AU - Layton C; Glasson W
TI -
Clinical aspects of conjunctival melanoma.
SO - Clin Experiment Ophthalmol 2002 Apr;30(2):72-9
AD - University of Queensland Medical School,Herston, Queensland, Australia.
cjlayton@bigpond.com
Conjunctival melanoma is a rare but important condition encountered in
ophthalmology. This paper reviews conjunctival melanoma as a clinical
entity, with particular emphasis on differential diagnosis, management
and prognostic factors. Relevant references were located through a
comprehensive search of articles published between 1980 and early 2001
on Medline, using both the WinSpirs and PubMed platforms. The references
of these articles were then checked for further articles of relevance.
The condition is uncommon and its presentation variable; therefore,
relevant studies were found to suffer from small numbers of subjects.
This may be the cause of the confusion that still surrounds the
condition and its management.
20
UI - 10900104
AU - Singh AD; Shields CL; Shields JA; Sato T
TI -
Uveal melanoma in young patients.
SO - Arch Ophthalmol 2000 Jul;118(7):918-23
AD - Oncology Service, Wills Eye Hospital, 900 Walnut St, Philadelphia, PA
19107, USA. arunsingh@eyetumors.com
OBJECTIVE: To study the clinical profile of young patients with uveal
melanoma. DESIGN: Retrospective case-control series. SETTING: Tertiary
referral center. PATIENTS: Data on 63 patients aged 20 years or younger
with uveal melanoma were reviewed for clinical profile and association
with oculo(dermal) melanocytosis, familial uveal melanoma, dysplastic
nevus syndrome, cutaneous melanoma, and other second malignant
neoplasms. RESULTS: Of 8000 patients with uveal melanoma, 63 (0.8%) were
found in patients who were 20 years of age or younger. The median age at
diagnosis was 16 years, and the youngest patient was 3 years old.
Sixty-two patients (98%) were white, and uveal melanoma was unilateral
in all cases. Seven patients (11%) had oculo(dermal) melanocytosis. Two
patients (3%) had dysplastic nevi syndrome, and personal history of
cutaneous melanoma was observed in 1 patient (2%). No other second
cancers were present in any patient. The 5- and 15-year posttreatment
survival estimates were 0.95 (95% confidence interval, 0.87-1.00) and
0.77 (95% confidence interval, 0.52-1.00), respectively. CONCLUSIONS:
Uveal melanoma is rare in children or teenagers. It occurs in a
heterogeneous group displaying various associations, especially with
oculo(dermal) melanocytosis. Oculo(dermal) melanocytosis is 9 times (95%
confidence interval, 3.6-22.8) more common in young patients with uveal
melanoma than in the general population with uveal melanoma. Young
patients with uveal melanoma have short-term (5-year) survival better
than that of adults, but the long-term (15-year) survival is similar to
that of adults. Arch Ophthalmol. 2000;118:918-923
21
UI - 11405856
AU - Kivela T
TI -
Iris melanomas in children.
SO - Arch Ophthalmol 2001 Jun;119(6):925-6
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