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NCI CANCERLIT® Search: Intraocular Melanoma - January 2002
National Cancer Institute®
Last Modified: January 1, 2002
Table of Contents
1
UI - 11151214
AU - Valverde Almohalla S; Martin Rodrigo J; Alvarez Viersou H; Encinas
TI -
Martin JL
[Posterior uveal pseudomelanoma. Clinical differential diagnosis at the
referral hospital]
SO - Arch Soc Esp Oftalmol 2000 Aug;75(8):529-34
AD - Servicio de Oftalmologia del Hospital Universitario Clinica Puerta de
Hierro, Madrid, Espana.
PURPOSE: To determine the rate of patients referred with diagnosis of
posterior uveal melanoma to a referral hospital for such disease who
were excluded for such diagnosis resting on clinical approach. To
determine which are the most frequent corrected diagnosis. METHODS:
Retrospective review of clinical histories of patients referred to the
Department of Ophthalmology of Hospital Universitario Clinica Puerta de
posterior uveal melanoma. RESULTS: Two hundred and eighty eight patients
with clinical diagnosis of posterior uveal melanoma were admitted. Two
hundred and eighteen of these were confirmed in their diagnosis. From
the cases with corrected diagnosis, 23 correspond to small posterior
uveal melanocytic tumors, 9 to posterior uveal nevi and 38 (13.2%) to
lesions other than uveal melanocytic tumor. The most frequent diagnoses
in the last group were spontaneous subretinal hemorrhages (11 cases) and
vasoproliferative retinal tumors (6 cases). The average age of patients
with subretinal hemorrhage was 72.5 +/- 8.5 years versus 55.8 +/- 14.8
years in those diagnosed of posterior uveal melanocytic tumor (PUMT)
(Posterior uveal melanoma, small posterior uveal melanocytic tumor or
posterior uveal nevus) (p=0.0002). Seven out of 11 (63.6%) were males
versus 113 of 250 (45.2%) with PUMT. (.) Seven of 11 (63.6%) showed
associated vitreous hemorrhage versus 8 of 250 (3.2%) PUMT (p<0.0001).
(.) The average height was 2.34 +/- 1.57 mm in subretinal hemorraghes
versus 5.37 +/- 3 mm in PUMT (p=0.03). Only 2 out of 11 showed signs of
age related macular degeneration. CONCLUSIONS: The discrepance rate
(13.2% at least) between referral diagnosis and diagnosis of referral
hospital for such uncommon disease as posterior uveal melanoma account
for the consolidation of this referral department not only as a
treatment but also as a diagnostic one. Spontaneous subretinal
hemorrhages and vasoproliferative retinal tumors are the diseases that
raise most of diagnostic confusions. Differential diagnosis of both of
them is simple considering their clinical and epidemiologic features, in
the hands of ophthalmologists expert in intraocular tumors.
2
UI - 11151253
AU - Arrevola Velasco L; Domingo Gordo B; Acero Pena A; Fernandez De Castro
TI -
Pombo J; Martinez Montero JC
[Melanoma of the eyelid margin: clinical management and oncopathologic
study]
SO - Arch Soc Esp Oftalmol 2000 Oct;75(10):705-8
AD - Instituto Oftalmico, Hospital General Universitario Gregorio Maranon,
Madrid, Espana.
OBJECTIVE/METHODS: A 57 year-old male patient with a very pigmented
tumor of the margin of the upper lid and two months of evolution is
presented. After its excision and histopathological study, the diagnose
was nodular melanoma. RESULTS/CONCLUSIONS: We expose the treatment and
clinical management of this unfrequent pathology. Different clinical
features and other locations in the eyelid are discussed regarding the
prognosis.
3
UI - 11370500
AU - Munzenrider JE
TI -
Uveal melanomas. Conservation treatment.
SO - Hematol Oncol Clin North Am 2001 Apr;15(2):389-402
AD - Department of Radiation Oncology, Massachusetts General Hospital,
Boston, Massachusetts, USA.
Eye conservation can be achieved in patients with uveal melanomas by
several techniques, with external beam charged particle (proton) therapy
and episcleral radionuclide plaque therapy being used most commonly. The
probability of visual preservation and of eye retention with either
technique is related to tumor size and location. If vision is poor or
absent in the fellow eye, even very large tumors can be treated with the
proton beam, with a 75% to 80% probability of eye salvage and
preservation of some degree of visual function. Local control is
achieved in a large proportion of treated eyes with either technique
probably because of the large doses that can be focally administered to
these relatively small tumors with those techniques. Achieving local
control may also contribute to improved survival in some patients.
Survival clearly has not been compromised. Useful vision is preserved in
eyes with tumors occurring in a favorable location with respect to the
optic disc or macula. A dose-searching trial, aimed at improving visual
outcome in patients with tumors in unfavorable locations, has been
completed and has provided data to aid in designing future trials.
Successfully treating uveal melanoma without removal of the involved eye
is one of the major oncologic triumphs of the latter part of the 20th
century. Very high rates of local control can be achieved with heavy
charged particle external beam radiotherapy or 125I episcleral plaque
brachytherapy, with preservation of a functionally useful eye in many
patients. The excellent results in the eye melanoma patients treated
with external beam proton therapy also demonstrate that almost all the
patients can successfully cooperate in their treatment by voluntarily
fixating the eye on a particular point during treatment, so that their
tumor is positioned properly in the beam during treatment. Conservative
treatment can achieve local control rates similar to or superior to
those achieved with radiation therapy alone in other commonly treated
solid tumors, including early stage carcinomas of the breast, vocal
cord, and prostate. Continued careful follow-up of conservatively
treated patients will provide even better understanding of the radiation
effects on uveal melanomas and on normal ocular structures. It is also
impressive that these gains have not been achieved at a cost of
increased mortality: survival rates in irradiated patients are at least
as good as after enucleation. Further observation will reveal whether
these initial dramatic and encouraging results will be maintained. The
COMS Study may provide additional data in this regard at least regarding
survival after brachytherapy relative to enucleation. It will not,
however, clarify indications for the two types of radiotherapy
(brachytherapy and charged particle therapy) nor will it allow direct
comparisons of acute and chronic ocular effects of those therapeutic
modalities. The UCSF-LBL trial mentioned previously, which compared
helium ion therapy with 125I episcleral plaque treatment, has documented
the superiority of charged particle therapy to plaque therapy in terms
of local tumor control and eye retention. Of interest is a recent survey
reporting that choice of treatment for uveal melanoma did not seem to be
associated with large differences in quality of life when assessed at
long-term follow-up. The distant failures and metastatic deaths in uveal
melanoma patients, more common with larger and more anteriorly located
tumors, are most distressing. A randomized clinical trial of adjuvant
systemic therapy is clearly indicated but has not been mounted because
of the relatively poor results obtained with systemic therapy in
metastatic melanoma patients. The recent report of improved survival in
cutaneous melanoma patients at high risk for metastasis who were treated
with interferon is encouraging, and it led to the initiation of the
nonrandomized study described previously, which uses interferon
following proton eye irradiation for patients with increased risk of
metastasis. Other trials would clearly be indicated if more effective
systemic therapies become available.
4
UI - 11456016
AU - Regan S; Egan KM; Hart L; Gragoudas ES
TI -
Color Doppler imaging of untreated and irradiated choroidal melanomas.
SO - Eur J Ophthalmol 2001 Apr-Jun;11(2):150-5
AD - Massachusetts Eye and Ear Infirmary, Retina Service, Boston 02114, USA.
PURPOSE: We examined untreated and irradiated choroidal melanomas with
color Doppler imaging (CDI), a noninvasive method providing quantitative
measures of blood flow, to determine if the tumor vessel damage
associated with irradiation can be detected using this technology.
METHODS: CDI was performed on 122 untreated and 76 previously irradiated
tumors using a Q2000 color Doppler ultrasound unit. Spectral analysis
was performed on all detectable vascular regions within the tumor to
obtain estimates of the peak systolic and end diastolic flow velocities
and resistive index ((syst-diast)/syst). RESULTS: Vessels were detected
in 93% of the untreated tumors and in 63% of the treated tumors
(p<0.001, X2), and the median number of vascular regions found was
higher among untreated tumors (3 vs 1, p=0.001, Wilcoxon Rank Sum). The
effect of treatment status on the detection of tumor vessels was
significant (p=0.039), controlling for age, sex, largest tumor
pretreatment diameter, and tumor height at CDI in a logistic regression
model. Mean resistive index was lower in the untreated tumors (0.53 vs
0.58, p=0.0050), controlling for tumor height and other covariates in an
analysis of variance. CONCLUSIONS: On examination with CDI, irradiated
tumors had fewer detectable vascular regions and greater resistance to
flow than untreated tumors, a pattern consistent with known radiation
effects.
5
UI - 10919885
AU - Eskelin S; Pyrhonen S; Summanen P; Hahka-Kemppinen M; Kivela T
TI -
Tumor doubling times in metastatic malignant melanoma of the uvea: tumor
progression before and after treatment.
SO - Ophthalmology 2000 Aug;107(8):1443-9
AD - Department of Ophthalmology, Helsinki University Central Hospital,
Helsinki, Finland. sebastian.eskelin@helsinki.fi
OBJECTIVE: To obtain estimates of growth rate of metastatic uveal
melanoma to infer appropriate follow-up programs and to assess the
impact of current chemoimmunotherapy regimens. DESIGN: Retrospective
case series. PARTICIPANTS: Of 70 consecutive patients diagnosed with
metastatic uveal melanoma from 1986 through 1998, 37 patients who
attended regular follow-up and had measurable metastases were eligible
for this study. METHODS: Tumor doubling time (DT) was calculated by the
Schwartz formula using three presumed sizes of metastasis at last
negative follow-up. DT was compared according to tumor characteristics,
and time of micrometastasis was estimated. MAIN OUTCOME MEASURES:
Doubling time of untreated and treated metastases. RESULTS: Doubling
time of untreated metastases ranged from 34 to 220 days (median, 63
days). Regardless of the presumed size of metastasis at last screening,
two thirds of the metastases had a DT between 30 and 80 days. No
significant correlation between DT and the observed disease-free
interval was detected. Assuming constant growth rate, most metastases
had predictably initiated within 5 years before primary treatment. Mean
DT during active treatment of metastases in 18 patients who did not show
an objective response ranged from 25 to 2619 days (median, 255 days).
CONCLUSIONS: Based on the estimated growth rates, a rational follow-up
interval to detect metastatic uveal melanoma would be 4 to 6 months.
Primary uveal melanomas that develop clinically detectable metastasis
after conservative therapy may micrometastasize several years before
treatment. These estimates are rough and must be confirmed by
prospective studies. Current chemoimmunotherapy regimens slow down the
growth rate of metastases even if objective response is not obtained.
6
UI - 11508891
AU - Balestrazzi A; Blasi MA; Scupola TA; Balestrazzi TE
TI -
Retinal detachment due to macular hole after transpupillary
thermotherapy of choroidal melanoma.
SO - Retina 2001;21(4):384-5
AD - Department of Ophthalmology and Neurosurgery, University of Siena,
Italy. bale@freemail.it
7
UI - 11552413
AU - Bechrakis NE; Bornfeld N; Zoller I; Foerster MH
TI -
[Iodine-125 brachytherapy and trans-scleral tumor resection in large
uveal melanomas]
SO - Ophthalmologe 2001 Aug;98(8):736-42
AD - Augenklinik, Universitatsklinikum Benjamin Franklin, Freie Universitat
Berlin, Hindenburgdamm 30, 12200 Berlin. bechrakis@medizin.fu-berlin.de
BACKGROUND: The treatment of large uveal melanomas is always a challenge
to the ophthalmic oncologist due to the expected long-term
complications. The purpose of this study was to compare 125Iodine plaque
brachytherapy with transscleral resection of large uveal melanomas in
terms of preserving visual function and avoiding secondary enucleation.
PATIENTS AND METHODS: A total of 135 patients with similar tumor
features were selected from a group of 211 patients with uveal melanomas
where the tumor height was greater than 7.5 mm. Of these patients 87
were treated by 125Iodine brachytherapy and 48 patients by transscleral
tumor resection. The mean follow-up time was 26 months. RESULTS: After
transscleral resection 58% of the patients and after
125Iodine-brachytherapy 15% of the patients retained a visual acuity of
> or = 0.1 after a follow-up of 28 months. Following
iodine-brachytherapy there was a sixfold higher rate of secondary
glaucoma. No difference was found with respect to the eye retention and
mortality rate. CONCLUSION: Patients with large melanomas eligible for
transscleral local resection have a better visual function than those
treated by 125Iodine brachytherapy.
8
UI - 11572072
AU - Terheyden P; Rickert S; Kampgen E; Munnich S; Hofmann UB; Brocker EB;
TI -
Becker JC
[Nevus of Ota and choroid melanoma]
SO - Hautarzt 2001 Sep;52(9):803-6
AD - Universitatshautklinik, Julius-Maximilians Universitat, Wurzburg.
A 59-year-old patient presented with metastatic uveal melanoma that
developed in a nevus of Ota. The nevus of Ota or oculodermal
melanocytosis contains an increased number of dermal melanocytes in the
distribution of the ophthalmic and maxillary divisions of the trigeminal
nerve. Malignant transformation arising in a nevus of Ota may occur in
all anatomical sites influenced by the nevus. Most often the choroid is
involved. Although the nevus of Ota is rare in Caucasians, associated
melanoma is more common than in Asians or black people. The
dermatologist should be aware of this problem and aim at an
interdisciplinary management of these patients.
9
UI - 11578728
AU - Dieckmann K; Bogner J; Georg D; Zehetmayer M; Kren G; Potter R
TI -
A linac-based stereotactic irradiation technique of uveal melanoma.
SO - Radiother Oncol 2001 Oct;61(1):49-56
AD - Department of Radiotherapy and Radiobiology, University of Vienna,
General Hospital Vienna, Wahringer Gurtel 18-20, 1090, Vienna, Austria.
PURPOSE: To describe a stereotactic irradiation technique for uveal
melanomas performed at a linac, based on a non-invasive eye fixation and
eye monitoring system. METHODS: For eye immobilization a light source
system is integrated in a standard stereotactic mask system in front of
the healthy eye: During treatment preparation (computed
tomography/magnetic resonance imaging) as well as for treatment
delivery, patients are instructed to gaze at the fixation light source.
A mini-video camera monitors the pupil center position of the diseased
eye. For treatment planning and beam delivery standard stereotactic
radiotherapy equipment is used. If the pupil center deviation from a
predefined 'zero-position' exceeds 1 mm (for more than 2 s), treatment
delivery is interrupted. Between 1996 and 1999 60 patients with uveal
melanomas, where (i) tumor height exceeded 7 mm, or (ii) tumor height
was more than 3 mm, and the central tumor distance to the optic disc
and/or the macula was less than 3 mm, have been treated. A total dose of
60 or 70 Gy has been given in 5 fractions within 10 days. RESULTS: The
repositioning accuracy in the mask system is 0.47+/-0.36 mm in
rostral-occipital direction, 0.75+/-0.52 mm laterally, and 1.12+/-0.96
mm in vertical direction. An eye movement analysis performed for 23
patients shows a pupil center deviation from the 'zero' position<1 mm in
91% of all cases investigated. In a theoretical analysis, pupil center
deviations are correlated with GTV 'movements'. For a pupil center
deviation of 1 mm (rotation of the globe of 5 degrees ) the GTV is still
encompassed by the 80% isodose in 94%. CONCLUSION: For treatments of
uveal melanomas, linac-based stereotactic radiotherapy combined with a
non-invasive eye immobilization and monitoring system represents a
feasible, accurate and reproducible method. Besides considerable
technical requirements, the complexity of the treatment technique
demands an interdisciplinary team continuously dedicated to this task.
10
UI - 11583680
AU - Goto H; Usui M; Wakamatsu K; Ito S
TI -
5-S-cysteinyldopa as diagnostic tumor marker for uveal malignant
melanoma.
SO - Jpn J Ophthalmol 2001 Sep-Oct;45(5):538-42
AD - Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan.
PURPOSE: To evaluate the clinical significance of 5-S-cysteinyldopa
(5-S-CD), a major intermediate in melanin synthesis, as a potential
diagnostic tumor marker for uveal malignant melanoma. METHODS: The
levels of 5-S-CD in the serum were measured by high-performance liquid
chromatography in 16 patients with primary uveal melanoma. The levels of
5-S-CD were also measured in both aqueous and vitreous humor in 10
patients with uveal melanoma. The serum of healthy volunteers and
patients with skin diseases other than melanoma, and the intraocular
fluids of patients with cataract and vitreoretinal diseases were used as
controls. RESULTS: Serum concentrations of 5-S-CD in patients with uveal
melanoma in the absence of extraocular metastases were close to those of
controls; however, serum concentrations of 5-S-CD were significantly
elevated in patients with extraocular metastases of melanoma.
Concentrations of 5-S-CD in the intraocular fluids, especially vitreous
humor, were higher in patients with uveal melanoma than in controls.
CONCLUSIONS: 5-S-CD in intraocular fluids may serve as a useful
biochemical marker for the diagnosis of uveal melanoma. Serum 5-S-CD may
contribute to the assessment of the presence and progression of
extraocular metastases in patients with uveal melanoma.
11
UI - 11590472
AU - Spraul CW; Gackle HC; Lang GK
TI -
[Malignant transformation of a choroidal nevus 6 years after
brachytherapy of a non-contiguous choroidal melanoma - a case report and
review of literature]
SO - Klin Monatsbl Augenheilkd 2001 Sep;218(9):626-31
AD - Universitats-Augenklinik Ulm, Prittwitzstrasse 43, 89075 Ulm, Germany.
christoph.spraul@medizin.uni-ulm.de
BACKGROUND: Brachytherapy is a well established procedure for treatment
of malignant choroidal processes. Approximately 5 % of the cases, will
show local recurrences within 6 years. We report a patient who has
developed a malignant transformation of an uveal nevus following
brachytherapy of a non-contiguous uveal melanoma. In addition, we
reviewed the literature concerning similar cases. HISTORY AND SIGNS: In
1991 a Ruthenium application was performed on a 65-year old patient
suffering of an equatorial malignant choroidal melanoma. At that time, a
nevus at the posterior pole was present. From 1997 to 1998 the nevus
continuously increased in size. Visual acuity decreased and a retinal
detachment developed. Combining the clinical and the sonographic
findings, the diagnosis of a malignant melanoma arising of a nevus was
established. Enucleation was performed in 1998. THERAPY AND OUTCOME:
Histologic examination revealed the diagnosis of an
epithelioid-cell-type malignant uveal melanoma arising in a nevus. Till
now, the patient is free of metastatic disease. CONCLUSION:
Non-contiguous development of uveal melanomas in the same eye are
extremely rare. We could identify in the literature 5 cases of
non-contiguous melanomas following brachytherapy of an uveal melanoma.
In none of these cases, the secondary melanoma has arisen in a nevus.
Follow-up examination of patients with uveal melanoma treated with
brachytherapy should include not only examination of the treated area,
but also the whole fundus of the eye in order to recognize secondary
tumours as early as possible.
12
UI - 11590473
AU - Spraul CW; Lang GK
TI -
[Diffuse melanocytic nevus of the iris and absolute glaucoma]
SO - Klin Monatsbl Augenheilkd 2001 Sep;218(9):632-4
AD - Universitats-Augenklinik Ulm, Prittwitzstrasse 43, 89075 Ulm, Germany.
christoph.spraul@medizin.uni-ulm.de
BACKGROUND: Ferry et al. (8) showed that 35 % of eyes which have been
enucleated because of a clinically suspected malignant iris lesion did
not reveal a histologically malignant iris tumor. PATIENT: A 43-year old
male presented with a blind, painful left eye, which has developed over
a time period of 6 months. Ophthalmologic examination revealed the
presence of pigmented iris stromal lesions associated with diffuse
pigmentation of the chamber angle and the development of absolute
glaucoma. A diffuse iridociliary malignant melanoma (ring melanoma) was
suspected and the blind painful eye was enucleated. Histologic
examination revealed the presence of a benign melanocytic lesion, i.e. a
spindle cell nevus of the iris with surface plaques causing diffuse
extension of the chamber angle, trabecular meshwork, Schlemm's canal,
and the ciliary body. CONCLUSION: The malignant potential of iris
lesions may be difficult to assess on clinical grounds only.
Histologically, benign melanocytic proliferation may cause diffuse
extension into the ciliary body as well as the chamber angle leading to
an increase in intraocular pressure. In order to reach a final diagnosis
a biopsy of the lesion is necessary.
13
UI - 11673294
AU - Lumbroso L; Desjardins L; Levy C; Plancher C; Frau E; D'Hermies F;
TI -
Schlienger P; Mammar H; Delacroix S; Nauraye C; Ferrand R; Desblancs C;
Mazal A; Asselain B
Intraocular inflammation after proton beam irradiation for uveal
melanoma.
SO - Br J Ophthalmol 2001 Nov;85(11):1305-8
AD - Department of Ophthalmology, Institut Curie, 26 rue d'Ulm, 75005 Paris,
France.
AIM: To describe the inflammatory reaction that can occur following
proton beam irradiation of uveal melanomas based on a large series of
patients and to try to determine the risk factors for this reaction.
METHODS: Data from a cohort of patients with uveal melanoma treated by
proton beam irradiation between 1991 and 1994 were analysed. The
presence of inflammation was recorded and evaluated. Kaplan-Meier
estimates and statistical analysis of general and tumour related risk
factors were performed. RESULTS: 28% of patients treated during this
period presented with ocular inflammation (median follow up 62 months).
Risks factors were essentially tumour related and were correlated with
larger lesions (height > 5 mm, diameter > 12 mm, volume > 0.4 cm(3)).
Multivariate analysis identified initial tumour height and irradiation
of a large volume of the eye as the two most important risk factors.
Ocular inflammation usually consisted of mild anterior uveitis,
resolving rapidly after topical steroids and cycloplegics. The incidence
of inflammation after proton beam irradiation of melanomas seems higher
than previously reported and is related to larger lesions. Evidence of
inflammation associated with uveal melanoma has been described and seems
to be associated with tumour necrosis (spontaneous or after
irradiation). The appearance of transient inflammation during the follow
up of these patients may be related to the release of inflammatory
cytokines during tumour necrosis. CONCLUSION: Inflammation following
proton beam irradiation is not unusual. It is correlated with larger
initial tumours and may be related to tumour necrosis.
14
UI - 11673295
AU - Lee J; Logani S; Lakosha H; Schroeder RP; Simpson R; Jampol LM
TI -
Preretinal neovascularisation associated with choroidal melanoma.
SO - Br J Ophthalmol 2001 Nov;85(11):1309-12
AD - Department of Ophthalmology, Northwestern University Medical School, 645
N Michigan Avenue Suite 440, Chicago, IL 60611, USA.
BACKGROUND: The rare occurrence of iris neovascularisation and choroidal
(subretinal) neovascularisation in patients with choroidal melanoma has
been reported. However, the occurrence of preretinal neovascularisation
(NVE) fed from the retinal circulation in eyes with choroidal melanoma
is far less frequently reported. METHODS: Three case reports of
choroidal melanoma with the very rare finding of overlying NVE. RESULTS:
The three patients had choroidal melanomas, localised serous retinal
detachment, and NVE. Two cases showed definite retinal capillary
non-perfusion, and one of these two cases demonstrated retinal
telangiectasis. One patient's melanoma responded quickly to iodine-125
plaque radiotherapy; however, the retinal neovascularisation persisted
and caused vitreous haemorrhage. Localised scatter photocoagulation was
successful in causing the complete regression of the neovascularisation.
The other two patients had their eyes enucleated (one with planned
pre-enucleation external beam radiotherapy). Demonstration of preretinal
vessels in one of the cases was possible in histological sections.
CONCLUSION: Preretinal neovascularisation may occur as a complication of
choroidal melanoma. Possible aetiologies include the release of tumour
angiogenic factors, inflammation, chronic retinal detachment with
secondary retinal ischaemia, retinal vascular occlusion secondary to
retinal vessel invasion by the tumour, or following radiation therapy.
Optimal management of the neovascularisation is not known at this time.
Supplemental localised scatter photocoagulation may be of benefit in
some cases.
15
UI - 11683945
AU - Sharara NA; Alexander RA; Luthert PJ; Hungerford JL; Cree IA
TI -
Differential immunoreactivity of melanocytic lesions of the conjunctiva.
SO - Histopathology 2001 Oct;39(4):426-31
AD - Pathology Department, Institute of Ophthalmology, University College
London, UK.
AIMS: To evaluate the expression of S100NKI/C3 and HMB45 antigens in
melanocytic lesions of the conjunctiva and the ability of HMB45 to aid
assessment of neoplasia. METHODS AND RESULTS: Stored formalin-fixed
specimens of conjunctival melanomas and primary acquired melanosis were
considered as participants and conjunctival naevi and racial melanosis
as controls. Ninety-seven conjunctival melanocytic lesions were analysed
using formalin-fixed paraffin-embedded material. These included 20
melanomas arising in the context of primary acquired melanosis (PAM), 22
melanomas arising without evidence of pre-existing PAM, seven cases of
PAM with atypia, nine cases of PAM with no atypia, 35 conjunctival naevi
and four cases of racial melanosis. S100 and NKI/C3 were similarly
expressed in all lesions, with at least one of these markers positive in
100% of the lesions examined. HMB45 was expressed in 72.7% of primary
melanomas and 85% of melanomas in the context of PAM; 42.8% of PAM with
atypia expressed HMB45 while it was expressed in 11.1% of PAM without
atypia and 8.5% of naevi. Racial melanosis cases did not express HMB45.
S100 and NKI/C3 were expressed to a similar extent in all groups.
CONCLUSIONS: S100 and NKI/C3 are useful markers to assess the extent of
melanocytic lesions in the conjunctiva. HMB45 immunoreactivity can act
as a useful aid to histopathology for the distinction of benign from
malignant conjunctival lesions, particularly in the context of primary
acquired melanosis.
16
UI - 11706523
AU - Egerer G; Lehnert T; Max R; Naeher H; Keilholz U; Ho AD
TI -
Pilot study of hepatic intraarterial fotemustine chemotherapy for liver
metastases from uveal melanoma: a single-center experience with seven
patients.
SO - Int J Clin Oncol 2001 Feb;6(1):25-8
AD - Department of Medicine V, University of Heidelberg, Hospitalstrasse 3,
69115 Heidelberg, Germany. gerlinde_egerer@med.uni-heidelberg.de
BACKGROUND: Uveal melanoma is characterized by a high frequency of
hepatic metastases. For patients with liver metastases, who have a
median survival of 5 to 7 months, surgery and systemic conventional
melanoma were enrolled into a pilot trial of intraarterial fotemustine
therapy. An implantable Port-A-Cath catheter was inserted into the
hepatic artery for regional chemotherapy via the gastroduodenal artery.
Fotemustine 100 mg/m2 was administered intraarterially over a 4-h
period. The induction phase consisted of one administration per week for
4 weeks, followed by a 5-week rest period. Maintenance therapy with
administration of fotemustine every 3 weeks continued until progression
or toxicity. RESULTS: Ten patients were evaluated for the trial. One
patient was not eligible because of impaired liver function, and in two
patients implantation of the port system was not possible for anatomic
reasons. Seven patients received a median of 16 treatment cycles (range,
4-28) and all were evaluable for response. Two patients achieved a
partial response (PR), three had stable disease (SD), and tumor
progressed in two patients (PD). The median survival time from diagnosis
of liver metastasis was 24 months (range, 4 to 50+ months). Two patients
survived for more than 2 years and two patients are still alive. The
toxicity was low and the treatment could be administered on an
outpatient basis. CONCLUSION: Intraarterial fotemustine treatment of
uveal melanoma metastatic to the liver is well tolerated, and in some
patients is associated with prolonged survival.
17
UI - 11689587
AU - Toivonen P; Kivela T
TI -
Unusual tumors involving the head and neck region: case 2. Malignant
uveal melanoma in ocular melanocytosis.
SO - J Clin Oncol 2001 Nov 1;19(21):4174-7
AD - Helsinki University Central Hospital, Helsinki, Finland.
18
UI - 11713084
AU - Cook BE Jr; Bartley GB
TI -
Treatment options and future prospects for the management of eyelid
malignancies: an evidence-based update.
SO - Ophthalmology 2001 Nov;108(11):2088-98; quiz 2099-100, 2121
AD - Oculoplastics Service, Department of Ophthalmology and Visual Sciences,
University of Wisconsin-Madison, Madison, Wisconsin, USA.
briggscook@yahoo.com
PURPOSE: To provide evidence-based clinical recommendations for
treatment options and future prospects for the management of common
malignant eyelid tumors, including global ratings for the strength of
published evidence supporting them. CLINICAL RELEVANCE: Approximately 5%
to 10% of all skin cancers occur in the eyelid. Incidence studies
indicate that basal cell carcinoma is the most frequent malignant eyelid
tumor, followed by squamous cell carcinoma, sebaceous gland carcinoma,
and malignant melanoma. Many therapeutic methods have been suggested to
combat the morbidity and mortality associated with these lesions.
LITERATURE REVIEWED: A MEDLINE and PubMed literature search (1966-1999)
was conducted for English language abstracts and appropriate (selected)
full-text references retrieved regarding treatment of malignant eyelid
tumors. These sources then were used to prepare recommendations for
patient care. Each recommendation was rated according to: (1) its
importance in the care process and (2) the strength of evidence
supporting the given recommendation. RESULTS: All recommendations were
rated as level A (very important to patient-care outcome). For basal
cell carcinoma, squamous cell carcinoma, and sebaceous gland carcinoma,
the published evidence supporting two recommendations (Mohs'
micrographic surgery or excision with frozen-section control) were
graded as I (providing strong evidence in support of a recommendation).
For sebaceous gland carcinoma, the recommendations also included
conjunctival map biopsies. The published evidence supporting all other
recommendations for these three eyelid tumors were graded II
(substantial evidence in support of a recommendation), primarily because
of the small numbers of patients in each clinical study. For malignant
melanoma, the recommendation for therapy (i.e., excision with variable
margins depending on tumor thickness) was based on published papers
individually variably rated as I, II, and III, reflecting ongoing debate
as to the best method of therapy. CONCLUSIONS: Published reports
regarding the treatment of malignant eyelid tumors include a myriad of
treatment options. The strongest evidence favors complete surgical
removal using histologic controls for verifying tumor-free margins of
excision.
19
UI - 11713086
AU - Esmaeli B; Wang X; Youssef A; Gershenwald JE
TI -
Patterns of regional and distant metastasis in patients with
conjunctival melanoma: experience at a cancer center over four decades.
SO - Ophthalmology 2001 Nov;108(11):2101-5
AD - Ophthalmology Section, The University of Texas M. D. Anderson Cancer
Center, Houston, Texas 77030, USA. besmaeli@mdanderson.org
OBJECTIVE: The regional lymph nodes generally are believed to be the
most common first site of metastasis for conjunctival malignant
melanoma, but the pattern of nodal metastasis in this disease has not
been well established. The goal of this study was to determine the
frequency, location, and timing of regional lymph node metastasis in
patients with conjunctival melanoma treated at one cancer center over
four decades. DESIGN: Retrospective case series. PARTICIPANTS:
Twenty-seven patients. METHODS: The clinical records of 27 patients with
conjunctival malignant melanoma were reviewed retrospectively. MAIN
OUTCOME MEASURES: The rates of local conjunctival recurrence, regional
nodal metastasis, and distant metastasis were analyzed along with
overall survival. The follow-up time ranged from 2.5 to 17 years
(median, 6 years). RESULTS: Eleven patients (41%) experienced clinical
regional lymph node metastasis 1.5 to 6.0 years (mean, 3.2 years) after
the initial diagnosis. The involved lymphatics were the preauricular
(parotid) nodes in 8 patients (73%), the submandibular nodes in 1
patient (9%), and the deeper cervical nodes in 2 patients (18%). In
seven patients (26%), distant metastasis developed without evidence of
prior or concurrent regional nodal disease. Patients in whom distant
metastasis developed without clinical evidence of regional nodal
involvement were more likely to have had local conjunctival recurrence
(P = 0.03) and a higher number of local recurrences (P = 0.05) compared
with patients with regional lymph nodes as the site of first metastasis.
The 5- and 10-year overall survival rates were 74% and 41%,
respectively. CONCLUSIONS: Regional lymph node metastasis occurred in a
higher percentage of patients with conjunctival malignant melanoma than
has been reported previously. Preauricular lymph nodes were most
commonly involved. Distant metastasis without prior or concurrent lymph
node involvement was not a rare event.
20
UI - 11734517
AU - Patel KA; Edmondson ND; Talbot F; Parsons MA; Rennie IG; Sisley K
TI -
Prediction of prognosis in patients with uveal melanoma using
fluorescence in situ hybridisation.
SO - Br J Ophthalmol 2001 Dec;85(12):1440-4
AD - Department of Surgical and Anaesthetic Sciences, Royal Hallamshire
Hospital, Sheffield S10 2JF, UK.
BACKGROUND/AIMS: Uveal melanoma is the commonest malignancy of the eye,
with a high proportion of patients dying of metastatic disease. Tumours
showing a loss of chromosome 3 and gains of chromosome 8 are associated
with a worse prognosis. The efficiency of fluorescence in situ
hybridisation (FISH) in determining copy numbers of these chromosomes
was assessed in individual tumours and related to patient survival.
METHODS: 33 fresh frozen samples were analysed with centromeric probes
for chromosomes 3 and 8. Patient outcomes were divided into two groups:
(1) absence of genetic abnormalities (no genetic imbalance) and (2)
presence of genetic abnormalities (genetic imbalance). The log rank test
was used to compare survival, which was represented by Kaplan-Meier
survival curves. RESULTS: Of the 33 tumours analysed, 16 showed evidence
of genetic imbalances. Of these 16 tumours, 14 patients had died by the
end of the study, with 10 having died of liver metastases. Of the
tumours without evidence of genetic imbalances, five patients had died
by the end of the study, although none had died as a result of either
liver metastases or from the primary uveal melanoma. The difference in
survival between the two groups was highly significant (p<0.0001).
CONCLUSION: The authors have shown that FISH analysis for chromosome 3
and 8 is a reliable and efficient technique in the analysis of fresh
frozen tumour specimens and is valuable in the prediction of prognosis
in individuals with uveal melanomas.
21
UI - 9392536
AU - Castro JR; Char DH; Petti PL; Daftari IK; Quivey JM; Singh RP; Blakely
TI -
EA; Phillips TL
15 years experience with helium ion radiotherapy for uveal melanoma.
SO - Int J Radiat Oncol Biol Phys 1997 Dec 1;39(5):989-96
AD - The University of California, San Francisco, Medical Center, USA.
PURPOSE: To review the long-term experience of helium ion therapy as a
therapeutic alternative to enucleation for uveal melanoma, particularly
with respect to survival, local control, and morbidity. METHODS AND
MATERIALS: 347 patients with uveal melanoma were treated with helium ion
RT from 1978-1992. A nonrandomized dose-searching study was undertaken,
with doses progressively reduced from 80 GyE in five fractions to 48 GyE
in four fractions, given in 3-15 days, mean of 7 days. RESULTS: Local
control was achieved in 96% of patients, with no difference in the rate
of local control being seen at 80, 70, 60, or 50 GyE in five fractions.
At the lowest dose level of 48 GyE in four fractions, the local control
rate fell to 87%. Fifteen of 347 patients (4%) had local regrowth in the
eye requiring enucleation (12 patients), laser (1 patient) or
reirradiation (2 patients). The time of appearance of local regrowth
ranged from 4 months to 5 years posttreatment, with 85% occurring within
3 years. Of the 347 patients, 208 are alive as of May 1, 1997. The
median follow up of all patients is 8.5 years, range 1-17 years.
Kaplan-Maier (K-M) survival is 80% at 5 years, 76% at 10 years, and 72%
at 15 years posttreatment. Patients with tumors not involving the
ciliary body have a 15-year K-M survival of 80%. The results for
patients whose tumors involved the ciliary body are poor, with a 15-year
K-M survival of 43%. Seventy-five percent of patients with tumors at
least 3.0 mm from the fovea and optic nerve, and initial ultrasound
height less than 6.0 mm, retained vision of 20/200 or better
posttreatment. Patients with tumors larger than 6 mm in thickness, or
with tumors lying close to the optic nerve or fovea, have a reduced
chance of retaining useful vision. The enucleation rate is 19%, 3% for
local failure and 16% because of complications of the helium RT,
particularly neovascular glaucoma, which occurred in 35% of patients.
CONCLUSIONS: Local control and retention of the eye are excellent.
Complications of therapy reduce vision and eye preservation. Twenty-four
percent of patients manifested distant metastases 6 to 146 months
posttreatment, mean of 43 months, median of 36 months. Late-appearing
distant metastases do not appear to be caused by persistent tumor in the
eye. The risk of metastases is high for patients with tumors greater
than 7 mm in initial ultrasound height (37%), anterior tumors involving
the ciliary body (47%), and in those with local failure (53%). Patients
with tumors not involving the ciliary body and initial dimensions less
than 10 mm had only an 8% chance of death from melanoma. A search for
effective adjuvant therapy is needed for patients at high risk of
metastases (large tumors, ciliary body involved, local regrowth in eye).
22
UI - 11761564
AU - Cools D; Debiec-Rychter M; Parys-Van Ginderdeuren R; Hagemeijer-Hausman
TI -
A; Van den Oord J; Spileers W
Preliminary results of the FRO project: chromosomal abnormalities in
primary uveal melanoma.
SO - Bull Soc Belge Ophtalmol 2000;(278):67-70
AD - Dienst Oogziekten, St Rafael UZ Leuven.
Uveal melanoma is the most common primary intraocular tumor in adults in
the western world. Recent studies indicate that the presence of
cytogenetic abnormalities in tumor cells is strongly linked with
prognosis. The purpose of this project is the detection of chromosomal
abnormalities in a series of frozen tumors (retrospective study) and of
fresh tumor tissues (prospective study) and to correlate these results
with other prognostic factors and survival.
23
UI - 11767039
AU - Fenton S; Sandinha T; Lee WR; Kemp EG
TI -
Massive extraocular extension as the presenting feature of a choroidal
melanoma.
SO - Eye 2001 Aug;15(Pt 4):550-1
24
UI - 11503936
AU - Lee DS; Anderson SF; Perez EM; Townsend JC
TI -
Amelanotic choroidal nevus and melanoma: cytology, tumor size, and
pigmentation as prognostic indicators.
SO - Optom Vis Sci 2001 Jul;78(7):483-91
AD - Veterans Affairs Greater Los Angeles Healthcare System, Sepulveda
Ambulatory Care Center & Nursing Home, Sepulveeda, California 91343,
USA.
BACKGROUND: Choroidal nevi are fairly common lesions of the posterior
pole that can sometimes transform into melanoma, and it is thought that
most choroidal melanomas arise from preexisting nevi. Occasionally,
these lesions present as nonpigmented or amelanotic variations of their
pigmented counterparts. Recent studies suggest a relationship between
tumor pigmentation and risk of growth and metastasis, with a better
prognosis for lightly pigmented or amelanotic lesions. CASE REPORTS: A
case of an amelanotic choroidal nevus and melanoma are presented. In
Case 1, a 26-year-old white female was found to have a large amelanotic
nevus in the right eye. After 7 years of periodic observation, the
lesion has not changed. In Case 2, a 51-year-old white male was
diagnosed with a large amelanotic melanoma in the left eye. Due to
extensive involvement of the optic nerve, the patient underwent
enucleation. Histological evaluation confirmed the lesion as a
mixed-cell type malignant amelanotic melanoma. CONCLUSION: Management of
choroidal nevi generally consists of periodic observation, and the most
widely accepted management of choroidal melanoma is observation,
radiotherapy, and transpupillary thermotherapy or enucleation. The
therapeutic modality of choice for melanoma will vary depending on the
size, growth, and location of the lesion. In addition, recent studies
suggest an association between heavy tumor pigmentation, tumor size,
cell type, and risk of metastasis. Although many variables will
influence the final treatment option, pigmentation of the lesion should
also be considered.
25
UI - 11745500
AU - Hemminki K; Jiang Y
TI -
Association of ocular melanoma with breast cancer but not with cutaneous
melanoma: results from the Swedish Family-Cancer Database.
SO - Int J Cancer 2001 Dec 15;94(6):907-9
26
UI - 11604053
AU - Chan MF; Fung AY; Hu YC; Chui CS; Amols H; Zaider M; Abramson D
TI -
The measurement of three dimensional dose distribution of a
ruthenium-106 ophthalmological applicator using magnetic resonance
imaging of BANG polymer gels.
SO - J Appl Clin Med Phys 2001 Spring;2(2):85-9
AD - Department of Medical Physics, Memorial Sloan-Kettering Cancer Center,
1275 York Ave, New York, New York 10021, USA. chanm@mskcc.org
The BANG (MGS Research Inc., Guilford, CT) polymer gel has been used as
a dosimeter to determine the three-dimensional (3D) dose distribution of
a ruthenium-106 (Ru-106) ophthalmologic applicator. An eye phantom made
of the BANG gel was irradiated with the Ru-106 source for up to 1 h. The
phantom and a set of calibration vials were scanned simultaneously in a
GE 1.5 T MR imager using the Hahn spin-echo pulse sequence with a TR of
2000 ms and two TEs of 20 ms and 100 ms. The T(2) values were evaluated
on a pixel-by-pixel basis using custom-built software on a DEC alpha
workstation and converted to dose using calibration data. Depth doses
and isodose lines of the Ru-106 eye-plaque were generated. It is
concluded that the BANG gel dosimetry offers the potential for measuring
the 3D dose distributions of an ophthalmologic applicator, with high
spatial resolution and relatively good accuracy.
27
UI - 11545460
AU - Guenel P; Laforest L; Cyr D; Fevotte J; Sabroe S; Dufour C; Lutz JM;
TI -
Lynge E
Occupational risk factors, ultraviolet radiation, and ocular melanoma: a
case-control study in France.
SO - Cancer Causes Control 2001 Jun;12(5):451-9
AD - Inserm Unite 88, Hjpital National de Saint-Maurice, Saint-Maurice,
France. p.guenel@st-maurice.inserm.fr
BACKGROUND: Ultraviolet radiation has been suspected as a possible cause
of ocular melanoma. Because this association is controversial, we
examine the role of occupational exposure to ultraviolet radiation on
the occurrence of this rare cancer. MATERIAL AND METHODS: A
population-based case-control study was conducted in 10 French
administrative areas (departements). Cases were 50 patients with uveal
melanoma diagnosed in 1995-1996. Controls were selected at random from
electoral rolls, after stratification for age, gender, and area. Among
630 selected persons, 479 (76%) were interviewed. Data on personal
characteristics, occupational history, and detailed information on each
job held were obtained from face-to-face interviews using a standardized
questionnaire. Estimates of occupational exposure to solar and
artificial ultraviolet light were made using a job exposure matrix.
RESULTS: Results show elevated risks of ocular melanoma for people with
light eye color, light skin color, and for subjects with several eye
burns. The analysis based on the job exposure matrix showed a
significantly increased risk of ocular melanoma in occupational groups
exposed to artificial ul
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