1
|
Selby LD, Wallner K, Hall E, Mayr N, Chvetsov A, Stacey AW. Simultaneous conjunctival melanomas in one eye treated with both adjuvant brachytherapy and proton beam radiotherapy. Am J Ophthalmol Case Rep 2025; 38:102281. [PMID: 40083364 PMCID: PMC11904566 DOI: 10.1016/j.ajoc.2025.102281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 09/15/2024] [Accepted: 02/13/2025] [Indexed: 03/16/2025] Open
Abstract
Purpose We describe a rare case of two simultaneous primary conjunctival melanomas in the same eye that were treated sequentially with both plaque brachytherapy and proton beam radiotherapy following wide surgical excision. Observations A 66-year-old male presented with two pigmented lesions that were concerning for conjunctival melanoma. One of the lesions was on the bulbar conjunctiva near the corneal limbus, and the other in the lower fornix. The lesions were surgically removed using the "no touch" technique, and pathology confirmed invasive melanoma in two separate locations on the same eye. The two lesions were then treated separately with two different forms of adjuvant radiation therapy. The forniceal tumor was treated with proton beam radiotherapy and the limbal lesion was treated with plaque brachytherapy. 30 months after radiation therapy was completed, there were no signs of local recurrence. Conclusions and importance The appropriate treatment for two primary malignancies in the same eye can be determined independently and, in some cases, can involve two different forms of radiation therapy.
Collapse
Affiliation(s)
- Laura D. Selby
- Department of Ophthalmology, University of Washington School of Medicine, 325 9th Avenue Box 359608, Seattle, WA, 98104, USA
| | - Kent Wallner
- Department of Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific Street Box Number 356043, Seattle, WA, 98195, USA
| | - Evan Hall
- Division of Hematology and Oncology, University of Washington Fred Hutchinson Cancer Center, 825 Eastlake Ave. E, Seattle, WA, 98109, USA
| | - Nina Mayr
- Department of Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific Street Box Number 356043, Seattle, WA, 98195, USA
| | - Alexei Chvetsov
- Department of Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific Street Box Number 356043, Seattle, WA, 98195, USA
| | - Andrew W. Stacey
- Department of Ophthalmology, University of Washington School of Medicine, 325 9th Avenue Box 359608, Seattle, WA, 98104, USA
| |
Collapse
|
2
|
Veisi A, Dastborhan Z, Dastmardi M, Rezaie Kanavi M, Rezaei S. Lacrimal Drainage System and Nasal Cavity Melanoma after Complete Treatment of Conjunctival Melanoma. Case Rep Ophthalmol Med 2024; 2024:1034939. [PMID: 38362357 PMCID: PMC10869194 DOI: 10.1155/2024/1034939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 01/04/2024] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
Malignant melanoma of the conjunctiva is a rare tumor of the ocular surface with potential fatal consequences and a high likelihood of recurrence. Although routes for extending the tumor, including local, hematogenous, and lymphatogenous, are pretty straightforward, the indirect extension through free-floating tumoral cells to the nasolacrimal duct is not described thoroughly. We report a case of malignant melanoma of the conjunctiva which presented with local recurrence in the intranasal cavity and lacrimal sac two years after the primary surgery (without involvement of the ocular surface and punctum on the second occasion). However, there was no evidence of distant metastasis on either occasion. This case demonstrates the possible noncontiguous spreading route of melanoma tumoral cells and highlights the need for attention to the surgical technique, and careful follow-up to detect further disease activity.
Collapse
Affiliation(s)
- Amirreza Veisi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Dastborhan
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mozhgan Rezaie Kanavi
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeid Rezaei
- Eye and Skull Base Research Centers, Five Senses Institute, Rasoul Akram Hospital, Iran University of Medical Science, Tehran, Iran
| |
Collapse
|
3
|
Alves M, Asbell P, Dogru M, Giannaccare G, Grau A, Gregory D, Kim DH, Marini MC, Ngo W, Nowinska A, Saldanha IJ, Villani E, Wakamatsu TH, Yu M, Stapleton F. TFOS Lifestyle Report: Impact of environmental conditions on the ocular surface. Ocul Surf 2023; 29:1-52. [PMID: 37062427 DOI: 10.1016/j.jtos.2023.04.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
Environmental risk factors that have an impact on the ocular surface were reviewed and associations with age and sex, race/ethnicity, geographical area, seasonality, prevalence and possible interactions between risk factors are reviewed. Environmental factors can be (a) climate-related: temperature, humidity, wind speed, altitude, dew point, ultraviolet light, and allergen or (b) outdoor and indoor pollution: gases, particulate matter, and other sources of airborne pollutants. Temperature affects ocular surface homeostasis directly and indirectly, precipitating ocular surface diseases and/or symptoms, including trachoma. Humidity is negatively associated with dry eye disease. There is little data on wind speed and dewpoint. High altitude and ultraviolet light exposure are associated with pterygium, ocular surface degenerations and neoplastic disease. Pollution is associated with dry eye disease and conjunctivitis. Primary Sjögren syndrome is associated with exposure to chemical solvents. Living within a potential zone of active volcanic eruption is associated with eye irritation. Indoor pollution, "sick" building or house can also be associated with eye irritation. Most ocular surface conditions are multifactorial, and several environmental factors may contribute to specific diseases. A systematic review was conducted to answer the following research question: "What are the associations between outdoor environment pollution and signs or symptoms of dry eye disease in humans?" Dry eye disease is associated with air pollution (from NO2) and soil pollution (from chromium), but not from air pollution from CO or PM10. Future research should adequately account for confounders, follow up over time, and report results separately for ocular surface findings, including signs and symptoms.
Collapse
Affiliation(s)
- Monica Alves
- Department of Ophthalmology and Otorhinolaryngology, University of Campinas Campinas, Brazil.
| | - Penny Asbell
- Department of Bioengineering, University of Memphis, Memphis, USA
| | - Murat Dogru
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Cantanzaro, Italy
| | - Arturo Grau
- Department of Ophthalmology, Pontifical Catholic University of Chile, Santiago, Chile
| | - Darren Gregory
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, USA
| | - Dong Hyun Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
| | | | - William Ngo
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Anna Nowinska
- Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Ian J Saldanha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Edoardo Villani
- Department of Clinical Sciences and Community Health, University of Milan, Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Tais Hitomi Wakamatsu
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo, Brazil
| | - Mitasha Yu
- Sensory Functions, Disability and Rehabilitation Unit, World Health Organization, Geneva, Switzerland
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| |
Collapse
|
4
|
Hopkins NS, Laplant JF, Randall MB, Wilson MW. Metastasis of Conjunctival Melanoma to the Cardiac Atrium: A Case Report. Ophthalmic Plast Reconstr Surg 2023; 39:e104-e107. [PMID: 36877542 DOI: 10.1097/iop.0000000000002361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
The authors present an unreported case of malignant conjunctival melanoma with metastasis to the right cardiac atrium. A 67-year-old woman with history of conjunctival melanoma of the OS presented with asymptomatic recurrence with new extension to the fornix. Surgical management was planned; however, the patient was admitted to the hospital with symptoms of heart and respiratory failure. She was found to have a large mass in the right atrium. The mass was resected and was found to be metastatic conjunctival melanoma. The patient received chemotherapy and her symptoms have improved. This case highlights the high recurrence rate of conjunctival melanoma and the importance of tumor surveillance.
Collapse
Affiliation(s)
| | | | - M Barry Randall
- Department of Ophthalmology, Hamilton Eye Institute
- Department of Pathology, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | | |
Collapse
|
5
|
Kestel S, Göçün FPU, Öğüt B, Erdem Ö. Clinicopathologic features and survival outcomes of ocular melanoma: a series of 31 cases from a tertiary university hospital. J Pathol Transl Med 2022; 56:187-198. [PMID: 35501671 PMCID: PMC9288897 DOI: 10.4132/jptm.2022.03.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background We aimed to determine the effect of clinicopathologic features on overall survival among Caucasian ocular melanoma patients in the Central Anatolia region of Turkey. Methods This single-center study included conjunctival (n = 12) and uveal (n = 19) melanoma patients diagnosed between January 2008 and March 2020. Clinicopathologic features and outcomes were reviewed retrospectively. Five cases were tested for BRAF V600 mutations with real-time polymerase chain reaction, and one case was tested with next-generation sequencing. Survival was calculated using the Kaplan-Meier method. Results Thirty-one patients had a mean initial age of 58.32 years (median, 61 years; range 25 to 78 years). There were 13 male and 18 female patients. The median follow-up time was 43.5 months (range, 6 to 155 months) for conjunctival melanoma and 35 months (range, 8 to 151 months) for uveal melanoma. When this study ended, eight of the 12 conjunctival melanoma patients (66.7%) and nine of the 19 uveal melanoma patients (47.4%) had died. The presence of tumor-infiltrating lymphocytes was related to improved overall survival in conjunctival melanoma (p = .014), whereas the presence of ulceration (p = .030), lymphovascular invasion (p = .051), tumor in the left eye (p = .012), tumor thickness of > 2 mm (p = .012), and mitotic count of >1/mm2 (p = .012) reduced the overall survival in conjunctival melanoma. Uveal melanoma tumors with the largest diameter of 9.1–15 mm led to the lowest overall survival among subgroups (p = .035). Involvement of the conjunctiva (p=.005) and lens (p = .003) diminished overall survival in uveal melanoma. BRAF V600 mutation was present in one case of conjunctival melanoma, GNAQ R183Q mutation was present in one case of uveal melanoma. Patients with uveal melanoma presented with an advanced pathological tumor stage compared to those with conjunctival melanoma (p = .019). Conclusions This study confirmed the presence of tumor-infiltrating lymphocytes as a favorable factor in conjunctival melanoma and conjunctival and lens involvement as unfavorable prognostic factors in uveal melanoma for overall survival, respectively.
Collapse
Affiliation(s)
- Selin Kestel
- Department of Pathology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | | | - Betül Öğüt
- Department of Pathology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Özlem Erdem
- Department of Pathology, Faculty of Medicine, Gazi University, Ankara, Turkey
| |
Collapse
|
6
|
Lodde GC, Jansen P, Möller I, Sucker A, Hassel JC, Forschner A, Eckardt J, Meier F, Reinhardt L, Kähler KC, Ziemer M, Schlaak M, Rahimi F, Schatton K, Meiss F, Gutzmer R, Pföhler C, Terheyden P, Schilling B, Sachse M, Heppt MV, Sindrilaru A, Leiter U, Zaremba A, Thielmann CM, Ugurel S, Zimmer L, Hadaschik E, Bechrakis NE, Schadendorf D, Westekemper H, Livingstone E, Griewank KG. Genetic characterization of advanced conjunctival melanoma and response to systemic treatment. Eur J Cancer 2022; 166:60-72. [PMID: 35279471 DOI: 10.1016/j.ejca.2022.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/03/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Conjunctival melanoma is a rare type of ocular melanoma, which is prone to local recurrence and metastasis and can lead to patient death. Novel therapeutic strategies have revolutionized cutaneous melanoma management. The efficacy of these therapies in conjunctival melanoma, however, has not been evaluated in larger patient cohorts. METHODS In this multi-center retrospective cohort study with additional screening of the ADOREG database, data were collected from 34 patients with metastatic conjunctival melanoma who received targeted therapy (TT) (BRAF ± MEK inhibitors) or immune checkpoint inhibitors (ICI) (anti-PD-1 ± anti-CTLA4). In 15 cases, tissue was available for targeted next-generation-sequencing (611 genes) and RNA sequencing. Driver mutations, tumor mutational burden, copy number variations and inflammatory/IFNγ gene expression signatures were determined. RESULTS Genetic characterization identified frequent BRAF (46.7%, 7/15), NRAS (26.7%, 4/15), NF1 (20%, 3/15), and TERT promoter (46.7%, 7/15) mutations. UV associated C>T and CC>TT mutations were common. Median follow-up time after start of first TT or ICI therapy was 13.2 months. In 26 patients receiving first-line ICI, estimated one-year progression-free survival (PFS) rate was 42.0%, PFS and overall survival (OS) 6.2 and 18.0 months, respectively. First-line TT was given to 8 patients, estimated one-year PFS rate was 54.7%, median PFS and OS 12.6 and 29.1 months, respectively. CONCLUSIONS Our findings support the role of UV irradiation in conjunctival melanoma and the genetic similarity with cutaneous melanoma. Conjunctival melanoma patients with advanced disease benefit from both targeted therapies (BRAF ± MEK inhibitors) and immune checkpoint inhibitors.
Collapse
Affiliation(s)
- Georg C Lodde
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany.
| | - Philipp Jansen
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany.
| | - Inga Möller
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany.
| | - Antje Sucker
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany.
| | - Jessica C Hassel
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany.
| | - Andrea Forschner
- Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany.
| | - Julia Eckardt
- Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Berlin, Germany.
| | - Friedegund Meier
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität (TU), Dresden, Germany.
| | - Lydia Reinhardt
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität (TU), Dresden, Germany.
| | - Katharina C Kähler
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - Mirjana Ziemer
- Department of Dermatology, Venereology and Allergology, University Hospital Leipzig, Leipzig, Germany.
| | - Max Schlaak
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Berlin, Germany; Department of Dermatology, Venereology and Allergology, LMU University Hospital Munich, Germany.
| | - Farnaz Rahimi
- Department of Dermatology, Venereology and Allergology, LMU University Hospital Munich, Germany.
| | - Kerstin Schatton
- Heinrich-Heine-University, Medical Faculty, Department of Dermatology, Düsseldorf, Germany.
| | - Frank Meiss
- Department of Dermatology, Venereology and Allergology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany;University Hospital Freiburg, Freiburg, Germany.
| | - Ralf Gutzmer
- Department of Dermatology, Venereology, Allergology and Phlebology, University Hospital Mühlenkreiskliniken Minden, Minden, Germany.
| | - Claudia Pföhler
- Saarland University Medical School, Department of Dermatology and Skin Cancer Center, Homburg/Saar, Germany.
| | - Patrick Terheyden
- Department of Dermatology, Venereology and Allergology, University Hospital Lübeck, Lübeck, Germany.
| | - Bastian Schilling
- Department of Dermatology, Venereology and Allergology, University Hospital Wuerzburg, Wuerzburg, Germany.
| | - Michael Sachse
- Department of Dermatology, Allergology and Phlebology, Klinikum Bremerhaven Reinkenheide, Germany.
| | - Markus V Heppt
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-7 Nürnberg (FAU), Erlangen, Germany.
| | - Anca Sindrilaru
- Department of Dermatology, University Hospital Ulm, Germany.
| | - Ulrike Leiter
- Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany.
| | - Anne Zaremba
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany.
| | - Carl M Thielmann
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany.
| | - Selma Ugurel
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany.
| | - Lisa Zimmer
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany.
| | - Eva Hadaschik
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany.
| | | | - Dirk Schadendorf
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany; German Consortium for Translational Cancer Research (DKTK), Partner Site Essen and German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | | | - Elisabeth Livingstone
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany.
| | - Klaus G Griewank
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany.
| |
Collapse
|
7
|
Bresler SC, Simon C, Shields CL, McHugh JB, Stagner AM, Patel RM. Conjunctival Melanocytic Lesions. Arch Pathol Lab Med 2022; 146:632-646. [PMID: 34424954 DOI: 10.5858/arpa.2021-0006-ra] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Conjunctival melanocytic lesions consist of a variety of neoplastic and nonneoplastic conditions. These include benign processes such as primary intraepithelial hypermelanosis and melanocytic hyperplasia, secondary forms of intraepithelial hypermelanosis and melanocytic hyperplasia, melanocytic nevi, melanocytic proliferations with malignant potential, and melanoma. OBJECTIVE.— To provide a concise yet comprehensive resource regarding the histopathologic diagnosis of conjunctival melanocytic lesions. We aim to detail and clarify the numerous classification schemes that exist for junctional melanocytic proliferations of the conjunctiva (known as primary acquired melanosis or PAM; also termed conjunctival melanocytic intraepithelial neoplasia or C-MIN). Although not uniformly adopted, C-MIN is classified by using a numeric system based on a defined set of criteria. A less complex scheme (conjunctival melanocytic intraepithelial lesion or CMIL) has recently been proposed by the World Health Organization. Additionally, we aim to update the reader regarding molecular features and prognostic indicators. DATA SOURCES.— Peer-reviewed literature and archived cases for illustration. CONCLUSIONS.— Accurate histologic classification is essential, as PAM/C-MIN/CMILs that have a significant potential to progress to invasive melanoma may be clinically indistinguishable from low-risk lesions. Conjunctival melanoma (CM) more closely resembles cutaneous melanoma in terms of its pathogenesis and molecular features, compared to melanoma arising at other mucosal sites or to uveal melanoma. Depth of invasion and ulceration status, among other factors, have emerged as important prognostic indicators in CM. Sentinel lymph node biopsy may provide further prognostic information. Lastly, integration of pathologic and clinical findings is essential at this anatomically sensitive location to determine appropriate clinical management.
Collapse
Affiliation(s)
- Scott C Bresler
- From Michigan Medicine Department of Pathology, University of Michigan, Ann Arbor (Bresler, Simon, McHugh, Patel)
- Michigan Medicine Department of Dermatology, University of Michigan, Ann Arbor (Bresler, Patel)
| | - Caroline Simon
- From Michigan Medicine Department of Pathology, University of Michigan, Ann Arbor (Bresler, Simon, McHugh, Patel)
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania (Shields)
| | - Jonathan B McHugh
- From Michigan Medicine Department of Pathology, University of Michigan, Ann Arbor (Bresler, Simon, McHugh, Patel)
| | - Anna M Stagner
- The Department of Pathology, Massachusetts General Hospital, Boston (Stagner)
- The Department of Ophthalmology, Massachusetts Eye and Ear, Boston (Stagner)
- Harvard Medical School, Boston, Massachusetts (Stagner)
| | - Rajiv M Patel
- From Michigan Medicine Department of Pathology, University of Michigan, Ann Arbor (Bresler, Simon, McHugh, Patel)
- Michigan Medicine Department of Dermatology, University of Michigan, Ann Arbor (Bresler, Patel)
| |
Collapse
|
8
|
Zurcher KS, Houghton OM, Shen JF, Seetharam M, Roarke MC, Yang M. Nuclear Medicine and Molecular Imaging in Nodal Staging and Surveillance of Ocular Melanoma: Case Reports and Review of the Literature. J Nucl Med Technol 2021; 49:275-280. [PMID: 33820860 DOI: 10.2967/jnmt.120.260539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/01/2021] [Indexed: 11/16/2022] Open
Abstract
Ocular melanoma (OM) is a rare noncutaneous malignancy and consists of 2 different subtypes based on the anatomic location in the eye: uveal melanoma and conjunctival melanoma. Like cutaneous melanoma, OM benefits from nuclear medicine and molecular imaging in nodal staging and clinical management. Through the illustration of 2 distinctive cases, we aim to demonstrate the complementary roles of standard lymphoscintigraphy, advanced SPECT/CT, 18F-FDG PET/CT, and 18F-FDG PET/MRI in accurate nodal staging and surveillance of OM. We also review the epidemiology, existing staging guidelines, and management of uveal melanoma and conjunctival melanoma.
Collapse
Affiliation(s)
| | | | - Joanne F Shen
- Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona; and
| | - Mahesh Seetharam
- Department of Hematology/Oncology, Mayo Clinic, Scottsdale, Arizona
| | | | - Ming Yang
- Department of Radiology, Mayo Clinic, Scottsdale, Arizona;
| |
Collapse
|
9
|
Virgili G, Parravano M, Gatta G, Capocaccia R, Mazzini C, Mallone S, Botta L. Incidence and Survival of Patients With Conjunctival Melanoma in Europe. JAMA Ophthalmol 2021; 138:601-608. [PMID: 32215588 DOI: 10.1001/jamaophthalmol.2020.0531] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Conjunctival melanoma (CM) is a rare ocular tumor. Estimates of incidence and survival of patients with CM are important to researchers and policy makers. Objective To estimate incidence and survival of patients with CM in Europe. Design, Setting, and Participants This population-based cohort study used data from 41 European cancer registries adhering to the RARECAREnet project. All individuals diagnosed as having malignant CM from January 1995 to December 2007 coded according to the International Classification of Diseases for Oncology, Third Edition codes C69.0 (conjunctiva) and 8720-8780 (melanoma) were included. Analysis began March 2019. Main Outcomes and Measures Trend estimates for incidence and for 5-year relative survival (the ratio of the measured survival of patients to the expected survival in the general population for the same country, age, sex, and calendar year). Crude, age-standardized, and bayesian incidence rates were calculated. Five-year relative survival was calculated by the Ederer II method with the cohort and period approach. Results A total of 724 patients 15 years or older (512 [70.7%] were 55 years or older; 366 [50.6%] were female) were analyzed with an overall crude incidence of CM (per 1 000 000 person/y) of 0.46 (95% CI, 0.42-0.49). Crude incidence was similar in men and women (0.48; 95% CI, 0.44-0.54 and 0.46; 95% CI, 0.41-0.51, respectively) and increased with age. Age-standardized incidence increased over time only in men and was the highest in Norway and the Netherlands (more than 0.70). Only 1 case in 14 years was estimated to occur in Iceland vs about 20 cases per year in large countries such as France and Germany. Percentage of 5-year survival (83.5 overall; 95% CI, 78.6-87.3) was not different between adult and elderly patients but showed large geographical disparities across European regions (range, 66-89) and improved markedly in male patients (from 76 in 1995-1998 to 86 in 2003-2007, with a difference of 10.2 [95% CI, 1.3-19.2]; P < .05) becoming similar to that of women in the last period. Conclusions and Relevance Although these data are only available through 2007 and based on registries not uniformly covering the European population, the study provides the first Europe-wide estimates of the incidence and relative survival of patients with CM using population-based data. Geographical differences in survival indicate room for outcome improvement in Southern, Northern, and Eastern European countries.
Collapse
Affiliation(s)
- Gianni Virgili
- AOU Careggi, Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Firenze, Florence, Italy
| | | | - Gemma Gatta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Cinzia Mazzini
- AOU Careggi, Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Firenze, Florence, Italy
| | | | - Laura Botta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | |
Collapse
|
10
|
Mazzini C, Pieretti G, Vicini G, Nicolosi C, Virgili G, Giansanti F. Extensive conjunctival melanoma successfully treated with surgical resection and pre- and postoperative topical mitomycin C. Eur J Ophthalmol 2020; 31:NP71-NP74. [PMID: 32674607 DOI: 10.1177/1120672120944027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To report a case of a large conjunctival melanoma (CM) successfully treated with surgical resection and pre- and postoperative topical mitomycin C (MMC). METHODS This is a single observational case report. RESULTS A 58-year-old man was referred to us for a large pigmented conjunctival lesion of the right eye. Slit lamp examination revealed an extensive pigmented lesion diffusely involving the temporal bulbar conjunctiva, with multifocal intensely dark areas and an elevated limbal component extending on the corneal surface. The remaining bulbar and forniceal conjunctiva was not involved. The lesion was clinically diagnosed as CM. Clinical examination and head and neck ultrasonography did not show regional lymphadenopathy. The patient was treated with neoadjuvant topical MMC 0.04% four times a day for 3 weeks. At the end of MMC therapy we observed a reduction in pigmentation and thickness of the lesion. Subsequently, the patient underwent surgical excision of the lesion with "no touch technique," double freeze-thaw cryotherapy of the margins and reconstruction of the tissue defect with amniotic membrane graft. Histopathologic examination of the specimen confirmed the presence of CM, surrounded by primary acquired melanosis with atypia. The excision margins were positive for tumor involvement, so we decided to perform an adjuvant treatment with other four cycles of topical MMC. CONCLUSIONS The patient was closely followed-up after the treatment, without any local or distant recurrence at 32 months.
Collapse
Affiliation(s)
- Cinzia Mazzini
- Unit of Ocular Oncology, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy.,Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Giulia Pieretti
- Unit of Ocular Oncology, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy.,Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Giulio Vicini
- Unit of Ocular Oncology, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy.,Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Cristina Nicolosi
- Unit of Ocular Oncology, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy.,Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Gianni Virgili
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Fabrizio Giansanti
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| |
Collapse
|
11
|
Mikkelsen LH. Molecular biology in conjunctival melanoma and the relationship to mucosal melanoma. Acta Ophthalmol 2020; 98 Suppl 115:1-27. [PMID: 32749776 DOI: 10.1111/aos.14536] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Lauge Hjorth Mikkelsen
- Eye Pathology Section; Departments of Pathology and Ophthalmology, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| |
Collapse
|
12
|
Oncologic and visual outcomes after postoperative proton therapy of localized conjunctival melanomas. Radiat Oncol 2019; 14:239. [PMID: 31881977 PMCID: PMC6935064 DOI: 10.1186/s13014-019-1426-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/22/2019] [Indexed: 02/03/2023] Open
Abstract
Introduction conjunctival melanomas have high local relapse rates. Oncologic and visual outcomes can be improved with proton therapy and no-touch surgery. Material and methods a monocentric retrospective study of consecutive patients treated with surgery and proton therapy for conjunctival melanoma was conducted. Proton therapy was performed to a total dose of 45 Grays physical dose delivered in eight fractions over two weeks. Results Ninety-two patients were included. The mean age was 63-year-old. 65.2% of patients had primary acquired melanosis. The mean tumor thickness and diameter was 2.5 mm and 7.0 mm respectively. The clinical stage was T1 in 71.6% of cases, with a quadrangular involvement of more than 90° in 69% of cases. Conjunctival melanomas were of epithelioid cell-type in 40% of cases. Mean follow-up was 4.7 years. Five-year local failure rate was 33.2%. Of 25 local recurrences, 14 were marginal/out-of-field, 4 in-field, others were undetermined. First surgery at expert center resulted in 24.3% of local failure at 5 years versus 38.7% if performed elsewhere (p = 0.41). Salvage exenteration was performed in 13 patients. Tumor stage and quadrangular involvement were significant factors for local failure. Five-year progression-free survival and cause-specific death rates were 61.5 and 3.6%. Stage and epithelioid type were associated with poorer progression-free survival. Trophic toxicity occurred in 22.9% of patients and was treated locally, with grafts in 7 patients. Glaucoma and cataract occurred in 13 and 22 patients respectively. Prognostic factors for visual deterioration were age, tumor extent (multifocality, quadrangular involvement > 180°) and cryotherapy. Conclusions 5-year local failure rate after postoperative proton therapy for conjunctival melanoma was of 33.2%. Radiation-induced complications were overall manageable.
Collapse
|
13
|
Conjunctival Melanoma: Genetic and Epigenetic Insights of a Distinct Type of Melanoma. Int J Mol Sci 2019; 20:ijms20215447. [PMID: 31683701 PMCID: PMC6862213 DOI: 10.3390/ijms20215447] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 12/19/2022] Open
Abstract
Conjunctival melanoma (CjM) is a rare, primary cancer of the ocular region. Genetic and epigenetic characteristics of conjunctival melanoma have not been completely elucidated yet. Conjunctival melanoma presents similarities with cutaneous melanoma, with substantial differences in the biological behavior. We reviewed the genetic and epigenetic insights of CjM involved in invasion and metastatic spread. CjM is commonly characterized by mutations of v-raf murine sarcoma viral oncogene homolog B1 (BRAF), neurofibromin 1 (NF1) and telomerase reverse transcriptase (TERT), high expression of mammalian target of rapamycin (mTOR) and heat shock protein 90 (HSP90), frequent phosphatase and tensin homolog (PTEN) loss and upregulation of specific miRNAs. These features should identify CjM as a distinct subset of melanoma with its own profile, which is more similar to cutaneous melanoma than mucosal melanoma and remarkably different from uveal melanoma.
Collapse
|
14
|
Balzer BWR, Cherepanoff S, Joshua AM, Giblin M, Conway RM, Anazodo AC. Conjunctival Melanoma in Childhood and Adolescence: A Systematic Review. Ocul Oncol Pathol 2019; 5:387-395. [PMID: 31768361 DOI: 10.1159/000497813] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/08/2019] [Indexed: 12/15/2022] Open
Abstract
Background Conjunctival melanoma is rare in adults and rarer in children. We systematically reviewed the presentation, diagnostic and management strategies as well as outcomes for conjunctival melanoma in children and adolescents. Methods The following databases were searched: Medline, Embase, Web of Science and Scopus for cases of conjunctival melanoma occurring in children and adolescents < 18 years of age. Results Seventeen studies with 32 patients (18 males) were identified. The median age at presentation was 11 years (range 4-18 years). Most patients were white. Most patients presented with a conjunctival mass or naevus with a recent history of growth or change. Excision biopsy provided diagnosis and management for all cases. Adjuvant chemotherapy and radiotherapy were also used. One patient had metastatic disease at diagnosis and 3 developed metastatic disease (range 1-10 months). Two patients died from disease and one was alive with metastatic disease. Two patients had disease recurrence. Outcomes were observed to be better where diagnosis was made earlier and "no-touch" excision biopsy was performed in an appropriate specialist setting. Conclusions Conjunctival melanoma occurs rarely in children and adolescents. Surgery is the mainstay of management. The prognosis is guarded in metastatic disease due to the small sample size and limited follow-up.
Collapse
Affiliation(s)
- Ben W R Balzer
- Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Svetlana Cherepanoff
- St. Vincent's Hospital, Darlinghurst, New South Wales, Australia.,Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Anthony M Joshua
- St. Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | | | - Robert Max Conway
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Antoinette C Anazodo
- Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia.,Kid's Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| |
Collapse
|
15
|
Rossi E, Maiorano BA, Pagliara MM, Sammarco MG, Dosa T, Martini M, Rindi G, Bria E, Blasi MA, Tortora G, Schinzari G. Dabrafenib and Trametinib in BRAF Mutant Metastatic Conjunctival Melanoma. Front Oncol 2019; 9:232. [PMID: 31024839 PMCID: PMC6460374 DOI: 10.3389/fonc.2019.00232] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 03/14/2019] [Indexed: 12/26/2022] Open
Abstract
Conjunctival melanoma is a rare primary ocular tumor. So far, no standard treatment exists for metastatic disease. Similarly to cutaneous melanoma, up to 50% of conjunctival melanomas harbor BRAF mutations. The most common is represented by V600E. Combined therapy with BRAF and MEK inhibitors is approved for BRAF mutant cutaneous metastatic melanomas. Herein, we report a case of a 70-years old patient with a metastatic conjunctival melanoma harboring V600E BRAF mutation successfully treated with dabrafenib and trametinib.
Collapse
Affiliation(s)
- Ernesto Rossi
- Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Brigida Anna Maiorano
- Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | | | | | - Tommaso Dosa
- Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Maurizio Martini
- Pathology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Guido Rindi
- Pathology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Emilio Bria
- Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | | | - Giampaolo Tortora
- Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Giovanni Schinzari
- Medical Oncology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| |
Collapse
|
16
|
NF1 mutations in conjunctival melanoma. Br J Cancer 2018; 118:1243-1247. [PMID: 29559732 PMCID: PMC5943412 DOI: 10.1038/s41416-018-0046-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 01/27/2018] [Accepted: 02/05/2018] [Indexed: 12/30/2022] Open
Abstract
Background Conjunctival melanoma is a potentially deadly eye tumour. Despite effective local therapies, tumour recurrence and metastasis remain frequent. The genetics of conjunctival melanomas remain incompletely understood. Methods A large cohort of 63 conjunctival melanomas was screened for gene mutations known to be important in other melanoma subtypes by targeted next-generation sequencing. Mutation status was correlated with patient prognosis. Results Frequent mutations in genes activating the MAP kinase pathway were identified. NF1 mutations were most frequent (n = 21, 33%). Recurrent activating mutations were also identified in BRAF (n = 16, 25%) and RAS genes (n = 12, 19%; 11 NRAS and 1 KRAS). Conclusions Similar to cutaneous melanomas, conjunctival melanomas can be grouped genetically into four groups: BRAF-mutated, RAS-mutated, NF1-mutated and triple wild-type melanomas. This genetic classification may be useful for assessment of therapeutic options for patients with metastatic conjunctival melanoma
Collapse
|
17
|
|
18
|
Conjunctival melanoma: association of cyclooxygenase-2 tumor expression to prognosis. Graefes Arch Clin Exp Ophthalmol 2018; 256:989-995. [DOI: 10.1007/s00417-017-3864-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 11/11/2017] [Accepted: 12/11/2017] [Indexed: 02/07/2023] Open
|
19
|
The Role for Sentinel Lymph Node Biopsy in the Management of Conjunctival Melanoma. Int Ophthalmol Clin 2016; 57:87-101. [PMID: 27898616 DOI: 10.1097/iio.0000000000000161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
20
|
Larsen AC. Conjunctival malignant melanoma in Denmark: epidemiology, treatment and prognosis with special emphasis on tumorigenesis and genetic profile. Acta Ophthalmol 2016; 94 Thesis 1:1-27. [PMID: 27192168 DOI: 10.1111/aos.13100] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Conjunctival malignant melanoma is a rare disease associated with considerable mortality. Most published data have been based on case reports or series of referred patients. In addition, very little is known about the genetic and epigenetic profile of conjunctival melanoma and the resemblance to uveal, cutaneous and mucosal melanoma. The aim was to determine the incidence rate of conjunctival melanoma, and to relate clinicopathological features and treatment to prognosis. A further aim was to determine the prevalence of BRAF mutations in conjunctival melanoma, to determine whether BRAF mutations are early events in pathogenesis, and relate clinicopathological features and prognosis to BRAF-mutation status. Finally, we wanted to identify tumour-specific and prognostic microRNAs in conjunctival melanoma, and to compare these with the microRNA expression of other melanoma subtypes. In order to investigate these rare tumours, we studied all the conjunctival melanomas that had been surgically removed in Denmark over a period of 52 years (1960-2012). Tissue samples, clinical files, pathology reports and follow-up data were collected and re-evaluated. Using droplet digital polymerase chain reaction and immunohistochemistry, we investigated BRAF mutations; and using microRNA expression profiling, we investigated differentially expressed microRNAs. The overall incidence of conjunctival melanoma was 0.5/1 000 000/year, and it increased in Denmark over 52 years. The increase was mainly caused by an increase in older patients (>65 years) and bulbar lesions. Clinicopathological features significantly associated with a poor prognosis were extrabulbar location, involvement of adjacent tissue structures, tumour thickness exceeding 2 mm and local tumour recurrence. Patients undergoing incisional biopsy and/or treatment involving excision without adjuvant therapy fared worse than patients treated with excision and any type of adjuvant treatment. We found that 35% (39/110) of conjunctival melanomas were BRAF-mutated, and the incidence of BRAF mutations was constant over time. BRAF-mutation status corresponded in conjunctival melanoma and paired premalignant lesions. BRAF mutations were more frequent in males, in young patients, and in tumours with a sun-exposed tumour location (bulbar conjunctiva or caruncle), with a mixed or non-pigmented colour, with absence of primary acquired melanosis, and with origin in a nevus. Immunohistochemistry was able to accurately detect BRAF V600E mutations. In univariate analysis, distant metastatic disease was associated with BRAF mutations. No prognostic associations with BRAF mutations were identified in multivariate analyses. MicroRNA expression analysis revealed 25 tumour-specific microRNAs in conjunctival melanoma. Five possibly oncogenic miRNAs (miR-20b-5p, miR-146b-5p, miR-146a-5p, miR-506-3p and miR-509-3p) were up-regulated. Seven microRNAs (miR-30d-5p, miR-138-5p, miR-146a-5p, miR-500a-5p, miR-501-3p, miR-501-5p and miR-502-3p) were significantly and simultaneously up-regulated in both stage T1 and stage T2 tumours, and were associated with increased tumour thickness. The expression of the 25 tumour-specific microRNAs did not differ significantly between conjunctival melanoma and oral or nasal mucosal melanoma. In conclusion, the incidence of conjunctival melanoma increased in the Danish population from 1960 to 2012. From our findings of a distinct pattern of BRAF mutations and differentially expressed microRNAs, it is evident that conjunctival melanoma is closely related to cutaneous and other mucosal melanomas and bears less resemblance to uveal melanomas. This means that conjunctival melanoma patients may benefit from therapies that are effective for cutaneous and mucosal melanoma. Additionally, the identification of several up-regulated microRNAs may prove to be useful as prognostic or therapeutic targets in conjunctival melanoma.
Collapse
Affiliation(s)
- Ann-Cathrine Larsen
- Department of Neuroscience and Pharmacology; University of Copenhagen; Copenhagen Denmark
| |
Collapse
|
21
|
Kao A, Afshar A, Bloomer M, Damato B. Management of Primary Acquired Melanosis, Nevus, and Conjunctival Melanoma. Cancer Control 2016; 23:117-25. [DOI: 10.1177/107327481602300205] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Andrew Kao
- Department of Ophthalmology, University of California, San Francisco, California
| | - Armin Afshar
- Department of Ophthalmology, University of California, San Francisco, California
| | - Michele Bloomer
- Department of Ophthalmology, University of California, San Francisco, California
| | - Bertil Damato
- Department of Ophthalmology, University of California, San Francisco, California
| |
Collapse
|
22
|
|
23
|
Sivkova N, Chokoeva AA, Dobrev H, Staribratova D, Belovezhdov V, Tchernev G, Wollina U. Malignant melanoma of the conjunctiva successful surgical excision of the primary tumor and reconstruction by conjunctival auto transplantation from the contralateral eye. Int J Immunopathol Pharmacol 2015; 27:629-34. [PMID: 25572743 DOI: 10.1177/039463201402700419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Malignant melanoma of the conjunctiva is a rare tumor with incidence of 0.5 cases/year per million population. It may also occur as de novo, as on the basis of preexisting melanocytic lesions (nevus or freckle) or most often from the so-called primary acquired melanosis of the conjuctiva (PAM). It metastasizes mainly lymphogenic and hematogenous. The size of the primary tumor lesion, histopathological findings and absolute tumor thickness are essential for unfavorable prognosis. Conjunctival auto transplantation from the other eye is modern and innovative, but also a seldomly feasible method of reconstruction after conjunctival excision of tumors in this area. We present a rare case of a 75-year-old patient with epithelioid cell malignant melanoma of the bulbar conjunctiva of the right eye, which de novo occurred, successfully treated by excision of the primary tumor and subsequent reconstruction by conjunctival auto transplant from the other eye. A very good therapeutic and aesthetic result was achieved.
Collapse
Affiliation(s)
- N Sivkova
- University Eye Clinic, University Hospital St George- Plovdiv, Department of Ophthalmology, Medical University of Plovdiv, Bulgaria
| | - A A Chokoeva
- Onkoderma- Policlinic for Dermatology and Dermatologic Surgery, General Skobelev 26 Sofia, Bulgaria
| | - H Dobrev
- Onkoderma- Policlinic for Dermatology and Dermatologic Surgery, General Skobelev 26 Sofia, Bulgaria
| | - D Staribratova
- Department of General and Clinical Pathology, Medical University of Plovdiv, University hospital St. George, Plovdiv, Bulgaria
| | - V Belovezhdov
- Department of General and Clinical Pathology, Medical University of Plovdiv, University hospital St. George, Plovdiv, Bulgaria
| | - G Tchernev
- Policlinic for Dermatology and Venereology, Saint Kliment Ohridski University, Medical Faculty, University Hospital, Sofia, Bulgaria
| | - U Wollina
- Department of Dermatology and Allergology, Dresden- Friedrichstadt Hospital, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| |
Collapse
|
24
|
Wong JR, Nanji AA, Galor A, Karp CL. Management of conjunctival malignant melanoma: a review and update. EXPERT REVIEW OF OPHTHALMOLOGY 2014; 9:185-204. [PMID: 25580155 DOI: 10.1586/17469899.2014.921119] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Conjunctival malignant melanoma is a pigmented lesion of the ocular surface. It is an uncommon but potentially devastating tumor that may invade the local tissues of the eye, spread systemically through lymphatic drainage and hematogenous spread, and recur in spite of treatment. Despite its severity, the rarity of available cases has limited the evidence for diagnosis and management. This review will provide an overview of the epidemiology, presentation, diagnosis, management, and surveillance of conjunctival melanoma, with an emphasis on recent advances in biological therapies to treat this disease.
Collapse
Affiliation(s)
- James R Wong
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Afshan A Nanji
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA ; Department of Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA
| | - Carol L Karp
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
25
|
Bredow L, Stützel L, Böhringer D, Gundlach E, Reinhard T, Auw-Haedrich C. Progesterone and estrogen receptors in conjunctival melanoma and nevi. Graefes Arch Clin Exp Ophthalmol 2013; 252:359-65. [PMID: 24276560 DOI: 10.1007/s00417-013-2523-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 09/03/2013] [Accepted: 11/07/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Since it has been observed that melanocytic lesions can alter their appearance during pregnancy, we analyzed whether hormone receptors are expressed in conjunctival nevi as well as conjunctival melanoma. We further analyzed whether the number of estrogen (ER) or progesterone receptors (PR) might be associated with the disease course in conjunctival melanoma. METHODS Twenty-seven paraffin-embedded samples of conjunctival nevi and 27 conjunctival melanoma specimens were examined using immunohistological analysis with antibodies against PR and ER. The percentage of stained cells were analyzed, taking into account patient gender and age. Out of the melanoma group, all patients with complete data for tumor thickness, tumor localization, age at diagnosis, gender, and follow-up including recurrence, metastasis and tumor-related death were included in the second part of the study (n = 15), where hormone receptor rates were associated with tumor outcome, regarding recurrences, metastasis or death. Written consent was received from all included patients. RESULTS Both nevi and melanomas showed high rates of PR- and ER-positive cells. In Nevi, 64 ± 25 % of cells stained positive for PR and 35 ± 34 % for ER. In melanoma specimens, 68 ± 30 % showed PR and 44 ± 34 % ER expression. Differences between men and women in expression rates were not statistically significant. Out of 15 melanoma patients (nine female, six male), 53 % (five women and three men) experienced 1-4 recurrences, and four patients developed metastases. The median estimated survival time was 12.2 years. A multivariate survival model taking into account known risk factors for prognosis in conjunctival melanoma confirmed tumor location to be an important predictive factor for outcome (p = 0.05). The rate of PR or ER did not show a statistically significant correlation with the disease course in our cohort. CONCLUSIONS We observed that conjunctival melanocytic lesions express hormone receptors, which could explain why these tumors can alter their appearance under hormonal changes. Regarding the prognosis of conjunctival melanoma, no statistically significant correlation between hormone receptor expression and event-free survival was found in this analysis.
Collapse
Affiliation(s)
- Laura Bredow
- University Eye Hospital Freiburg, Killianstr. 5, 79106, Freiburg im Breisgau, Germany,
| | | | | | | | | | | |
Collapse
|
26
|
Abstract
The value of F-18 fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET-CT) for the evaluation of cutaneous melanoma has been demonstrated previously. However, there are few reports regarding the use PET-CT for the staging of conjunctival melanoma (CM). We report here a case, a 34-year-old male with a six-month history of a pigmented nodule at the palpebral conjunctiva of the left eye, and a firm left preauricular lymph node detected on physical examination. Biopsy of the ocular lesion confirmed CM, and fine needle aspiration cytology of the preauricular node was positive for malignancy. CT showed three pulmonary nodules. An (18)F-FDG PET-CT was performed to restage the patient. The study showed hypermetabolic lesions in the left eye, and in the left preauricular node. The scan was negative for metastasis. These findings were important in guiding management of the disease in this patient. Future prospective studies should further evaluate the role of (18)F-FDG PET-CT for the staging of CM.
Collapse
Affiliation(s)
- Andres Damian
- Uruguayan Center of Molecular Imaging (CUDIM), University of Uruguay, Montevideo, Uruguay ; Nuclear Medicine Center, Clinical Hospital, University of Uruguay, Montevideo, Uruguay
| | | | | | | |
Collapse
|
27
|
Satué Palacián M, Garcia-Martin E, Fernández Tirado FJ, Pablo Júlvez LE. [Update and review of conjunctival melanoma treatment]. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2013; 88:247-249. [PMID: 23768470 DOI: 10.1016/j.oftal.2013.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 02/28/2013] [Indexed: 06/02/2023]
|
28
|
Griewank KG, Westekemper H, Murali R, Mach M, Schilling B, Wiesner T, Schimming T, Livingstone E, Sucker A, Grabellus F, Metz C, Süsskind D, Hillen U, Speicher MR, Woodman SE, Steuhl KP, Schadendorf D. Conjunctival melanomas harbor BRAF and NRAS mutations and copy number changes similar to cutaneous and mucosal melanomas. Clin Cancer Res 2013; 19:3143-52. [PMID: 23633454 DOI: 10.1158/1078-0432.ccr-13-0163] [Citation(s) in RCA: 147] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Conjunctival melanoma is a rare but potentially deadly tumor of the eye. Despite effective local therapies, recurrence and metastasis remain frequent. Once the tumor has metastasized, treatment options are limited and the prognosis is poor. To date, little is known of the genetic alterations in conjunctival melanomas. EXPERIMENTAL DESIGN We conducted genetic analysis of 78 conjunctival melanomas, to our knowledge the largest cohort reported to date. An oncogene hotspot array was run on 38 samples, screening for a panel of known cancer-relevant mutations. Thirty tumors were analyzed for genome-wide copy number alterations (CNA) using array-based comparative genomic hybridization. Sanger sequencing of selected target mutations was conducted in all samples. RESULTS BRAF mutations were identified in 23 of 78 (29%) tumors. NRAS mutations, previously not recognized as relevant in conjunctival melanoma, were detected in 14 of 78 (18%) tumors. We found CNAs affecting various chromosomes distributed across the genome in a pattern reminiscent of cutaneous and mucosal melanoma but differing markedly from uveal melanoma. CONCLUSIONS The presence of NRAS or BRAF mutations in a mutually exclusive pattern in roughly half (47%) of conjunctival melanomas and the pattern of CNAs argue for conjunctival melanoma being closely related to cutaneous and mucosal melanoma but entirely distinct from uveal melanoma. Patients with metastatic conjunctival melanoma should be considered for therapeutic modalities available for metastatic cutaneous and mucosal melanoma including clinical trials of novel agents.
Collapse
Affiliation(s)
- Klaus G Griewank
- Department of Dermatology, Institute of Pathology and Neuropathology, University Hospital, University Duisburg-Essen, Essen, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Pedersen SH, Kessing SV, Prause JU, Toft PB. Recurrence of a limbal conjunctival melanoma 30 years after lamellar corneo-sclero-conjunctival excision. Acta Ophthalmol 2013; 91:100-1. [PMID: 21595860 DOI: 10.1111/j.1755-3768.2011.02171.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Susan Helene Pedersen
- Faculty of Health Sciences, Department of Ophthalmology, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark
| | | | | | | |
Collapse
|
30
|
[Prominent conjunctival tumor]. Ophthalmologe 2013; 110:255-8. [PMID: 23354355 DOI: 10.1007/s00347-012-2753-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The case of a 57-year-old woman with a rapidly growing unpigmented conjunctival tumor is presented. Despite the clinical appearance the histology surprisingly confirmed a malignant melanoma of the conjunctiva. Various phenotypes and the rareness of this disease complicate a clinical diagnosis. Therapeutically, a complete excision of the tumor including a safety margin, adjuvant topical chemotherapy and closely monitored follow-up are crucial.
Collapse
|
31
|
Vira D, Pesce J, Glasgow BJ, Lai C, Elashoff D, Abemayor E, John MS. Parotidectomy and neck dissection in the management of conjunctival melanoma: are they necessary? Laryngoscope 2012; 122:2436-41. [PMID: 23007927 DOI: 10.1002/lary.23239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 01/09/2012] [Accepted: 01/17/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objectives of this study were to review traditional techniques for the management of conjunctival melanoma and assess the need for parotidectomy and neck dissection in the management of conjunctival melanoma. STUDY DESIGN Retrospective review. METHODS This study was a retrospective review conducted in a tertiary academic medical center of patients diagnosed with conjunctival melanoma over a 20-year period RESULTS There were 39 patients diagnosed with conjunctival melanoma identified from January 1990 to December 2010. Follow-up varied from 2 to 201 months (median, 25 months). Of the patients, 16 (41%) had local recurrences at the primary site, two (13%) of whom later presented with parotid disease. One patient with parotid recurrence had a subsequent neck dissection for confirmed metastatic spread. No patient in this series had metastatic cervical disease without initial spread to the parotid. The probability of disease-free survival at 1, 2, and 5 years was 77%, 68%, and 50%, respectively. The probability of parotid free progression at 1, 2, and 5 years was 100%, 96%, and 90%, respectively. CONCLUSIONS Conjunctival melanoma is a rare malignancy traditionally managed with aggressive treatment to optimize local control. The role for staging parotidectomy with or without neck dissection has been heavily debated. Based on our review, parotidectomy only needs to be undertaken when high suspicion for metastatic spread is present, such as a palpable or radiographically evident mass. In addition, without documented parotid disease, neck dissection is not required.
Collapse
Affiliation(s)
- Darshni Vira
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA.
| | | | | | | | | | | | | |
Collapse
|
32
|
Abstract
Pigmented conjunctival lesions primarily include melanoma, nevus, primary acquired melanosis (PAM), and complexion-associated melanosis. The incidence of conjunctival malignant melanoma (CMM) has significantly increased in the USA and Europe over the years, and it carries a very serious risk for metastasis and melanoma-related death. Conjunctival melanoma can arise de novo or from precursor lesions, nevus, and PAM. PAM is histologically separated into two distinct forms: PAM with atypia and without atypia. PAM with severe atypia progresses to malignant melanoma in up to 50% of cases and PAM without atypia virtually never progresses. Nevus is a benign melanocytic tumor that only rarely undergoes malignant transformation. Complexion-associated melanosis is frequently seen in more darkly pigmented individuals and does not progress to melanoma, although it can become very large. A detailed literature review on the various pigmented conjunctival lesions together with a schematic approach to diagnosis and management is presented.
Collapse
Affiliation(s)
- Patrick Oellers
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | |
Collapse
|
33
|
Nunes AT, Almeida L, Crujo C, Monteiro-Grillo M. When narrative medicine helps in the diagnosis of conjunctival melanoma - an exceptional case report. GMS OPHTHALMOLOGY CASES 2012; 2:Doc02. [PMID: 27625931 PMCID: PMC5015600 DOI: 10.3205/oc000009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Conjunctival melanoma is a relatively rare ocular malignancy with substantial associated morbidity and mortality. It can arise in previously unblemished and unpigmented regions (approximately 10% of cases), from a preexisting nevus (approximately 20% of cases), or from the flat, spreading pigmentation of primary acquired melanosis with atypia (60–70% of cases), actually called conjunctival melanocytic intraepithelial neoplasia (C-MIN) with atypia (histopathologically more accurately term). Purpose: The authors describe an extremely rare case of malignant conjunctival melanoma, with a long evolution, in a young black woman. Results: Until now the patient has not shown any sign of relapse of this melanoma, after local excision. Conclusion: Conjunctival melanoma is a condition of concern because of its rarity and lethal potential. Advances in the understanding and management of this neoplasm have markedly reduced the mortality and possibly the morbidity associated with this malignancy. We observe that there are some cases of conjunctival melanoma that might be cured with only a local excision with posterior cryotherapy without more aggressive methods. The practice of narrative medicine brings new possibilities in the diagnosis and collection of classical history.
Collapse
Affiliation(s)
- Ana Teresa Nunes
- Ophthalmology Department, Centro Hospitalar Lisboa Norte/Hospital Santa Maria, Lisboa, Portugal
| | - Leonor Almeida
- Ophthalmology Department, Centro Hospitalar Lisboa Norte/Hospital Santa Maria, Lisboa, Portugal
| | - Conceição Crujo
- Pathology Department, Centro Hospitalar Lisboa Norte/Hospital Santa Maria, Lisboa, Portugal
| | - Manuel Monteiro-Grillo
- Ophthalmology Department, Centro Hospitalar Lisboa Norte/Hospital Santa Maria, Lisboa, Portugal
| |
Collapse
|
34
|
Prognostic Significance of Tumor-Associated Lymphangiogenesis in Malignant Melanomas of the Conjunctiva. Ophthalmology 2011; 118:2351-60. [DOI: 10.1016/j.ophtha.2011.05.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 05/17/2011] [Accepted: 05/18/2011] [Indexed: 01/09/2023] Open
|
35
|
Outcomes in 15 Patients with Conjunctival Melanoma Treated with Adjuvant Topical Mitomycin C: Complications and Recurrences. Ophthalmology 2011; 118:1754-9. [DOI: 10.1016/j.ophtha.2011.01.060] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 01/25/2011] [Accepted: 01/28/2011] [Indexed: 11/23/2022] Open
|
36
|
Ramkumar HL, Brooks BP, Cao X, Tamura D, DiGiovanna JJ, Kraemer KH, Chan CC. Ophthalmic manifestations and histopathology of xeroderma pigmentosum: two clinicopathological cases and a review of the literature. Surv Ophthalmol 2011; 56:348-61. [PMID: 21684361 PMCID: PMC3137889 DOI: 10.1016/j.survophthal.2011.03.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 02/24/2011] [Accepted: 03/01/2011] [Indexed: 11/22/2022]
Abstract
Xeroderma pigmentosum is a rare, autosomal recessive disease caused by a defect in DNA repair. Patients with xeroderma pigmentosum often have cutaneous and ocular sun sensitivity, freckle-like skin pigmentation, multiple skin and eye cancers, and, in some patients, progressive neurodegeneration. Xeroderma pigmentosum predominantly affects the ultraviolet (UV) exposed ocular surface, resulting in eyelid atrophy and cancers, corneal dryness, exposure keratopathy, and conjunctival tumors. We report the clinical history and ocular pathology of two white women who had xeroderma pigmentosum with neurological degeneration: Case 1 (died at age 44 years) and Case 2 (died at age 45 years). Case 1, with mutations in the XPA gene, had more than 180 basal cell carcinomas of her skin and eyelids and died from complications of neurodegeneration. Case 2, with mutations in the XPD gene, was sun-protected and had three skin cancers. She died from complications of neurodegeneration and pneumonia. Both patients had bilateral pinguecula, corneal pannus, and exposure keratopathy. Case 1 had bilateral optic atrophy, and Case 2 had bilateral peripheral retinal pigmentary degeneration. Both patients developed retinal gliosis. The ophthalmic manifestations and pathology of xeroderma pigmentosum are discussed and reviewed with respect to this report and other cases in the literature. These cases illustrate the role of DNA repair in protection of the eyes from UV damage and neurodegeneration of the retina.
Collapse
Affiliation(s)
- Hema L. Ramkumar
- Immunopathology Section, Laboratory of Immunology, Chevy Chase, MD, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, 20611, USA
| | - Brian P. Brooks
- Unit on Pediatric, Developmental and Genetic Ophthalmology, Ophthalmic Genetics and Visual Function Branch; National Eye Institute, Peking University, Beijing, China
| | - Xiaoguang Cao
- Immunopathology Section, Laboratory of Immunology, Chevy Chase, MD, USA
- Department of Ophthalmology, People’s Hospital, Peking University, Beijing, China
| | - Deborah Tamura
- DNA Repair Section, Dermatology Branch, National Cancer Institute; National Institutes of Health, Bethesda, MD 20892-1857, USA
| | - John J. DiGiovanna
- DNA Repair Section, Dermatology Branch, National Cancer Institute; National Institutes of Health, Bethesda, MD 20892-1857, USA
| | - Kenneth H. Kraemer
- DNA Repair Section, Dermatology Branch, National Cancer Institute; National Institutes of Health, Bethesda, MD 20892-1857, USA
| | - Chi-Chao Chan
- Immunopathology Section, Laboratory of Immunology, Chevy Chase, MD, USA
| |
Collapse
|