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Grimes JM, Shah NV, Samie FH, Carvajal RD, Marr BP. Conjunctival Melanoma: Current Treatments and Future Options. Am J Clin Dermatol 2020; 21:371-381. [PMID: 31965542 DOI: 10.1007/s40257-019-00500-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Conjunctival melanoma is a rare tumor of the conjunctival epithelium with a heterogenous clinical presentation and a propensity for regional and distant metastatic spread. Guidelines for the treatment of local conjunctival melanoma are well-established, but there are no standard efficacious therapies for metastatic disease. Given that conjunctival melanoma is genetically similar to cutaneous melanoma and mucosal melanomas, targeted therapies effective in the treatment of these diseases, such as BRAF inhibitors and KIT inhibitors, may be effective in the treatment of patients with metastatic conjunctival melanoma. Other targeted small-molecule drugs in the drug development pipeline for the treatment of more prevalent melanomas could also be applicable to conjunctival melanoma. Furthermore, systemic immunotherapy treatments that are now a mainstay in the treatment of cutaneous melanoma, such as programmed cell death-1 and cytotoxic T lymphocyte-associated antigen-4 inhibitors, could also stand to benefit patients with metastatic conjunctival melanoma. Limited case reports provide clues about the effectiveness of both targeted small-molecule inhibitors and immunotherapy in patients with advanced local and metastatic conjunctival melanoma and give credence to the argument that conjunctival melanoma patients should be included in major trials studying new therapies in both cutaneous and mucosal melanomas where applicable.
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Clinical Update on Checkpoint Inhibitor Therapy for Conjunctival and Eyelid Melanoma. Int Ophthalmol Clin 2020; 60:77-89. [PMID: 32205655 DOI: 10.1097/iio.0000000000000308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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53
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Oculoplastics Abstracts. Ophthalmic Plast Reconstr Surg 2020. [DOI: 10.1097/iop.0000000000001602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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54
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Martel A, Oberic A, Moulin A, Zografos L, Bellini L, Almairac F, Hamedani M. Orbital exenteration and conjunctival melanoma: a 14-year study at the Jules Gonin Eye Hospital. Eye (Lond) 2020; 34:1897-1902. [PMID: 31959885 PMCID: PMC7608475 DOI: 10.1038/s41433-020-0767-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/10/2020] [Accepted: 01/10/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose To report our 14-year experience with orbital exenteration and assess risk factors for poor prognosis by focusing on conjunctival melanoma. Patients and method A retrospective study was conducted in our tertiary care centre (Jules Gonin Eye Hospital, Lausanne, Switzerland) between 2003 and 2017. Inclusion criteria were patients aged ≥18 years with a follow-up >12 months, without metastatic spread at the time of surgery. Data recorded were age, gender, tumour histology, surgical technique, postoperative complications, surgical margin status, local recurrence, postoperative radiation beam therapy and metastatic status. Results Twenty-five patients with a mean age of 63.2 years (38–92) were included. Conjunctival melanoma was the most frequently identified tumour (n = 14, 56%) followed by conjunctival squamous cell carcinoma (n = 4, 16%), sebaceous carcinoma (n = 3, 12%), choroidal melanoma (n = 2, 8%) and basal cell carcinoma (n = 2, 8%). Eighteen tumours (72%) originated from the conjunctival tissue. Clear surgical margins were achieved in 21 (84%) patients. Fourteen (56%) patients experienced distant metastases and died from metastatic spread after a mean follow-up of 52.3 months (6–120). The 1-, 3- and 5-year overall survival (OS) was 96%, 72% and 60%, respectively. In the univariate analysis, positive surgical margins, local recurrence and metachronous metastases were associated with a decreased OS (p = 0.002, p = 0.005 and p = 0.007, respectively). In the multivariate analysis, positive surgical margins and metachronous metastases were also associated with a decreased OS (p = 0.02 and p = 0.042, respectively). Conjunctival melanoma was not associated with a poorer prognosis (p = 0.280). Conclusion Free surgical margins are needed to increase OS. To achieve clearer surgical margins, neoadjuvant targeted therapies/immunotherapies may be considered.
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Affiliation(s)
- A Martel
- Ophthalmology Department, University Hospital of Nice, Nice, France. .,University of Cote d'Azur, Nice, France. .,Inserm U1065, Centre Méditerranéen de Médecine Moléculaire (C3M), Team 1, Nice, France.
| | - A Oberic
- Ophthalmology Department, Jules Gonin Eye Hospital, Lausanne, Switzerland
| | - A Moulin
- Ophthalmology Department, Jules Gonin Eye Hospital, Lausanne, Switzerland
| | - L Zografos
- Ophthalmology Department, Jules Gonin Eye Hospital, Lausanne, Switzerland
| | - L Bellini
- Inserm U1065, Centre Méditerranéen de Médecine Moléculaire (C3M), Team 1, Nice, France
| | - F Almairac
- University of Cote d'Azur, Nice, France.,Neurosurgery Department, University Hospital of Nice, Nice, France
| | - M Hamedani
- Ophthalmology Department, Jules Gonin Eye Hospital, Lausanne, Switzerland
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Martel A, Hamedani M, Lagier J, Bertolotto C, Gastaud L, Poissonnet G. [Does orbital exenteration still has a place in 2019?]. J Fr Ophtalmol 2019; 43:152-174. [PMID: 31831277 DOI: 10.1016/j.jfo.2019.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/30/2019] [Accepted: 04/01/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Orbital exenteration is a radical anatomically and psychologically disfiguring procedure. It is mostly performed for management of orbital cancers or cancers with orbital involvement. The lack of benefit in terms of overall survival and the development of new molecular therapies (targeted therapies, immunotherapy) in recent years leads us to question its use. The goal of our review is to answer to the following question: is orbital exenteration a viable procedure in 2019? MATERIALS AND METHODS A literature review was performed using the PUBMED and MEDLINE databases. The following terms were used then crossed with each other: "orbital exenteration", "exenterated socket", "overall survival", "life expectancy", "orbital reconstruction", "socket reconstruction". Oncology articles from the past 15 years were included and separated into those in the oculoplastic literature and those in the ENT literature. RESULTS Nineteen articles were included in this review. Eyelid tumours represent the main etiology of orbital exenteration. Basal cell carcinoma is the most frequently incriminated tumor, while sebaceous carcinoma and conjunctival squamous cell carcinoma are the most frequently encountered in Asian series. Non-conservative orbital exenteration is the most prevalent surgery performed. Orbital reconstruction depends on the surgeon's speciality: healing by secondary intention and split thickness skin grafts are mostly performed by oculoplastic surgeons, whereas regional or free flaps are mostly performed by ENT surgeons. Cerebrospinal fluid leakage is the most common intraoperative complication, encountered in 0 to 13 % of cases. The most common postoperative complications are ethmoid fistula and infection of the operative site, encountered in 0 to 50 % and 0 to 43 % of cases respectively. Orbital exenteration allows surgical resection of R0 tumors in 42.5 % to 97 % of cases. Overall survival following orbital exenteration is 83 % (50.5-97) and 65 % (37-92) at 1 and 5 years respectively. Identified risk factors for poor overall survival are: age, tumor histology (worse prognosis with choroidal melanoma, better prognosis with basal cell carcinoma), non-R0 surgical resection, locally advanced tumors (size>20mm, BCVA<20/400 and the presence of metastases at diagnosis). Recent studies have demonstrated favorable outcomes when managing locally advanced basal cell carcinoma, lacrimal gland cancer and conjunctival melanoma with targeted therapies or immunotherapies without performing orbital exenteration. CONCLUSION Orbital exenteration remains a major part of our therapeutic arsenal. Although orbital exenteration has failed to demonstrate any overall survival benefit, it allows satisfactory local control of the disease with an increasingly less invasive procedure. The development of targeted therapies and immunotherapies may change our therapeutic decisions in the future.
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Affiliation(s)
- A Martel
- Service d'ophtalmologie, centre hospitalier universitaire de Nice, hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France.
| | - M Hamedani
- Département d'oculoplastie, hôpital ophtalmique Jules Gonin, Lausanne, Suisse
| | - J Lagier
- Service d'ophtalmologie, centre hospitalier universitaire de Nice, hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France
| | - C Bertolotto
- Université Nice Côte d'Azur, Inserm, C3M, 151, route Saint-Antoine de Ginestière, 06204 Nice, France
| | - L Gastaud
- Service d'oncologie médicale, centre Antoine Lacassagne, 06204 Nice, France
| | - G Poissonnet
- Service de chirurgie oncologique cervico-faciale, centre Antoine Lacassagne, 06189 Nice, France
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56
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Cohen VML, O'Day RF. Management Issues in Conjunctival Tumours: Conjunctival Melanoma and Primary Acquired Melanosis. Ophthalmol Ther 2019; 8:501-510. [PMID: 31691901 PMCID: PMC6858423 DOI: 10.1007/s40123-019-00219-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Indexed: 01/01/2023] Open
Abstract
Conjunctival melanoma is a rare malignant condition of the ocular surface. It is potentially lethal, with regional lymph node spread often preceding distant solid-organ metastasis. Due to its rarity and the long latency between treatment and local recurrence or the development of metastases, it is difficult to study. The literature is composed entirely of case series of varying quality, and there is significant variability in the management of this condition. This commentary attempts to distil the evidence base to provide practical management tips for the clinician.
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Affiliation(s)
- Victoria M L Cohen
- Ocular Oncology Service, Moorfields Eye Hospital and St Bartholomew's Hospital, London, UK.
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital, University College London Institute of Ophthalmology, London, UK.
| | - Roderick F O'Day
- Ocular Oncology Service, Moorfields Eye Hospital and St Bartholomew's Hospital, London, UK
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Greater Tumor Thickness, Ulceration, and Positive Sentinel Lymph Node Are Associated With Worse Prognosis in Patients With Conjunctival Melanoma. Am J Surg Pathol 2019; 43:1701-1710. [DOI: 10.1097/pas.0000000000001344] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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58
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Targeted Biological Drugs and Immune Check Point Inhibitors for Locally Advanced or Metastatic Cancers of the Conjunctiva, Eyelid, and Orbit. Int Ophthalmol Clin 2019; 59:13-26. [PMID: 30908276 DOI: 10.1097/iio.0000000000000271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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59
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Jain P, Finger PT, Damato B, Coupland SE, Heimann H, Kenawy N, Brouwer NJ, Marinkovic M, Van Duinen SG, Caujolle JP, Maschi C, Seregard S, Pelayes D, Folgar M, Yousef YA, Krema H, Gallie B, Calle-Vasquez A. Multicenter, International Assessment of the Eighth Edition of the American Joint Committee on Cancer Cancer Staging Manual for Conjunctival Melanoma. JAMA Ophthalmol 2019; 137:905-911. [PMID: 31169891 PMCID: PMC6555476 DOI: 10.1001/jamaophthalmol.2019.1640] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Eye cancer staging systems used for standardizing patient care and research need to be validated. Objective To evaluate the accuracy of the eighth edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual in estimating metastatis and mortality rates of conjunctival melanoma. Design, Setting, and Participants This international, multicenter, registry-based case series pooled data from 10 ophthalmic oncology centers from 9 countries on 4 continents. A total of 288 patients diagnosed with conjunctival melanoma from January 1, 2001, to December 31, 2013, were studied. Data analysis was performed from July 7, 2018, to September 11, 2018. Interventions Treatments included excision biopsy, cryotherapy, topical chemotherapy, radiation therapy, enucleation, and exenteration. Main Outcomes and Measures Metastasis rates and 5-year and 10-year Kaplan-Meier mortality rates according to the clinical T categories and subcategories of the eighth edition of the AJCC Cancer Staging Manual. Results A total of 288 eyes from 288 patients (mean [SD] age, 59.7 [16.8] years; 147 [51.0%] male) with conjunctival melanoma were studied. Clinical primary tumors (cT) were staged at presentation as cT1 in 218 patients (75.7%), cT2 in 34 (11.8%), cT3 in 15 (5.2%), and cTx in 21 (7.3%). There were no T4 tumors. Pathological T categories (pT) were pTis in 43 patients (14.9%), pT1 in 169 (58.7%), pT2 in 33 (11.5%), pT3 in 12 (4.2%), and pTx in 31 (10.8%). Metastasis at presentation was seen in 5 patients (1.7%). Metastasis during follow-up developed in 24 patients (8.5%) after a median time of 4.3 years (interquartile range, 2.9-6.0 years). Of the 288 patients, 29 died (melanoma-related mortality, 10.1%) at a median time of 5.3 years (interquartile range, 1.8-7.0 years). The cumulative rates of mortality among patients with cT1 tumors were 0% at 1 year, 2.5% (95% CI, 0.7%-7.7%) at 5 years, and 15.2% (95% CI, 8.1%-27.4%) at 10 years of follow-up; among patients with cT2 tumors, 0% at 1 year, 28.6% (95% CI, 12.9%-58.4%) at 5 years, and 43.6% (95% CI, 19.6%-77.9%) at 10 years of follow-up; and among patients with cT3 tumors, 21.1% (95% CI, 8.1%-52.7%) at 1 year of follow-up and 31.6% (95% CI, 13.5%-64.9%) at 5 years of follow-up. Patients with cT2 and cT3 tumors had a significantly higher cumulative mortality rate compared with those presenting with cT1 tumors (log-rank P < .001). Patients with ulcerated melanomas had significantly higher risk of mortality (hazard ratio, 7.58; 95% CI, 1.02-56.32; P = .04). Conclusions and Relevance This multicenter, international, collaborative study yielded evidence that the conjunctival melanoma staging system in the eighth edition of the AJCC Cancer Staging Manual can be used to accurately estimate metastasis and mortality rates. These findings appear to support the use of AJCC staging as a tool for patient care and research.
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Affiliation(s)
- Puneet Jain
- Department of Ocular Tumor and Orbital Disease, The New York Eye Cancer Center, New York
| | - Paul T Finger
- Department of Ocular Tumor and Orbital Disease, The New York Eye Cancer Center, New York
| | - Bertil Damato
- Ocular Oncology Service, Department of Ophthalmology, University of California, San Francisco
| | - Sarah E Coupland
- Department of Ophthalmology, Royal Liverpool University Hospital, Liverpool, England.,Department of Pathology, Royal Liverpool University Hospital, Liverpool, England
| | - Heinrich Heimann
- Department of Ophthalmology, Royal Liverpool University Hospital, Liverpool, England.,Department of Pathology, Royal Liverpool University Hospital, Liverpool, England
| | - Nihal Kenawy
- Department of Ophthalmology, Royal Liverpool University Hospital, Liverpool, England.,Department of Pathology, Royal Liverpool University Hospital, Liverpool, England
| | - Niels J Brouwer
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marina Marinkovic
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Sjoerd G Van Duinen
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jean Pierre Caujolle
- Department of Ophthalmology, St Roch Hospital, Nice University Hospital, Nice, France
| | - Celia Maschi
- Department of Ophthalmology, St Roch Hospital, Nice University Hospital, Nice, France
| | - Stefan Seregard
- Department of Ophthalmology, St Erik's Eye Hospital, Karolinska Institute, Stockholm, Sweden.,Department of Pathology, St Erik's Eye Hospital, Karolinska Institute, Stockholm, Sweden
| | - David Pelayes
- Department of Ophthalmology, Carlos G. Durand Hospital, Buenos Aires, Argentina
| | - Martin Folgar
- Department of Ophthalmology, Carlos G. Durand Hospital, Buenos Aires, Argentina
| | - Yacoub A Yousef
- The Ocular Oncology Multidisciplinary Clinic, Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Hatem Krema
- The Eye Cancer Clinic, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Brenda Gallie
- The Eye Cancer Clinic, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Alberto Calle-Vasquez
- Department of Ophthalmology, Calle Ophthalmic and Orbit Center, Bogota, Distrito Capital, Colombia
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Bakhoum MF, Esmaeli B. Molecular Characteristics of Uveal Melanoma: Insights from the Cancer Genome Atlas (TCGA) Project. Cancers (Basel) 2019; 11:cancers11081061. [PMID: 31357599 PMCID: PMC6721321 DOI: 10.3390/cancers11081061] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 07/21/2019] [Accepted: 07/22/2019] [Indexed: 12/12/2022] Open
Abstract
The Cancer Genome Atlas (TCGA) uveal melanoma project was a comprehensive multi-platform deep molecular investigation of 80 uveal melanoma primary tissue samples supported by the National Cancer Institute. In addition to identification of important mutations for the first time, it identified four different clusters (subgroups) of patients paralleling prognosis. The findings of the TCGA marker paper are summarized in this review manuscript and other investigations that have stemmed from the findings of the TCGA project are reviewed.
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Affiliation(s)
- Mathieu F Bakhoum
- Shiley Eye Institute, Jacobs Retina Center, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA 92093, USA
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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61
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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: 0.8] [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.
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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
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Checkpoint inhibition immunotherapy for advanced local and systemic conjunctival melanoma: a clinical case series. J Immunother Cancer 2019; 7:83. [PMID: 30909967 PMCID: PMC6434860 DOI: 10.1186/s40425-019-0555-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/01/2019] [Indexed: 12/24/2022] Open
Abstract
Background Herein, we describe the use of systemic immunotherapy for both locally advanced and metastatic conjunctival melanoma. Current treatments for advanced conjunctival melanoma typically result in poor local control leading to disfiguring orbital exenteration surgery. Locoregional spread of conjunctival malignant melanoma typically requires pre-auricular and cervical lymph node dissection with post-operative adjuvant radiation therapy. In addition, classic systemic chemotherapy has been unsuccessful in the treatment of metastatic disease. Methods This is a retrospectively analyzed clinical case series of 5 patients with biopsy proven conjunctival melanoma who were treated with checkpoint inhibition therapy. Of these, 3 patients were treated for residual ocular disease present after failing multiple local therapies and refusing orbital exenteration surgery and two (with local ocular control) for metastatic conjunctival melanoma. Both those with locally advanced disease and patients with metastatic disease received an anti-PD1 agent in combination with another immunotherapeutic agent. All 5 were given multiple cycles of systemic anti-PD1 therapy, 1 was initially treated with single agent ipilimumab (3 mg/kg) prior to approval of anti-PD1 agents and two received interferon eye drops. As part of each ophthalmic examination, photographs of all conjunctival and eyelid surfaces were obtained. Systemic evaluations involved initial staging scans as well as periodic re-imaging. Results All cases have shown responses. Of the 2 complete responses, 1 was a patient with systemic disease. No patients developed ocular toxicity or loss of vision. However, systemic adverse effects included adrenal insufficiency, Grade-III colitis, Grade-II dermatitis, Grade-II hepatotoxicity and Grade-II pneumonitis. Conclusions This report suggests that systemic immunotherapy with or without topical interferon is effective in treatment of malignant melanoma of the conjunctiva. Therefore, it can be considered for patients with advanced local conjunctival melanoma, those who refuse orbital exenteration surgery and those with systemic metastasis.
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63
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Kenawy N, Kalirai H, Sacco JJ, Lake SL, Heegaard S, Larsen AC, Finger PT, Milman T, Chin K, Mosci C, Lanza F, Moulin A, Schmitt CA, Caujolle JP, Maschi C, Marinkovic M, Taktak AF, Heimann H, Damato BE, Coupland SE. Conjunctival melanoma copy number alterations and correlation with mutation status, tumor features, and clinical outcome. Pigment Cell Melanoma Res 2019; 32:564-575. [PMID: 30672666 PMCID: PMC6849808 DOI: 10.1111/pcmr.12767] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/09/2019] [Accepted: 01/17/2019] [Indexed: 01/03/2023]
Abstract
Relatively little is known about the genetic aberrations of conjunctival melanomas (CoM) and their correlation with clinical and histomorphological features as well as prognosis. The aim of this large collaborative multicenter study was to determine potential key biomarkers for metastatic risk and any druggable targets for high metastatic risk CoM. Using Affymetrix single nucleotide polymorphism genotyping arrays on 59 CoM, we detected frequent amplifications on chromosome (chr) 6p and deletions on 7q, and characterized mutation‐specific copy number alterations. Deletions on chr 10q11.21‐26.2, a region harboring the tumor suppressor genes, PDCD4, SUFU, NEURL1, PTEN, RASSF4, DMBT1, and C10orf90 and C10orf99, significantly correlated with metastasis (Fisher's exact, p ≤ 0.04), lymphatic invasion (Fisher's exact, p ≤ 0.02), increasing tumor thickness (Mann–Whitney, p ≤ 0.02), and BRAF mutation (Fisher's exact, p ≤ 0.05). This enhanced insight into CoM biology is a step toward identifying patients at risk of metastasis and potential therapeutic targets for systemic disease.
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Affiliation(s)
- Nihal Kenawy
- Liverpool Ocular Oncology Research Group, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Aintree University Hospital, Liverpool, UK
| | - Helen Kalirai
- Liverpool Ocular Oncology Research Group, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Joseph J Sacco
- Liverpool Ocular Oncology Research Group, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Clatterbridge Cancer Centre, Wirral, UK
| | - Sarah L Lake
- Liverpool Ocular Oncology Research Group, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Steffen Heegaard
- Eye Pathology Section, Department of Pathology and Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ann-Cathrine Larsen
- Eye Pathology Section, Department of Pathology and Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Carlo Mosci
- Ocular Oncology Service, Galliera Hospital, Genoa, Italy
| | | | - Alexandre Moulin
- Ophthalmic Pathology Laboratory and Department of Ophthalmology, Jules Gonin Eye Hospital, Lausanne, Switzerland
| | | | | | - Célia Maschi
- Ophthalmology Department, University Hospital of Nice, Nice, France
| | - Marina Marinkovic
- Ophthalmology Department, Leiden University Medical Centre, Leiden, The Netherlands
| | - Azzam F Taktak
- Liverpool Ocular Oncology Research Group, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Department of Medical Physics and Clinical Engineering, Royal Liverpool University Hospital, Liverpool, UK
| | - Heinrich Heimann
- Liverpool Ocular Oncology Research Group, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Liverpool Ocular Oncology Centre, Royal Liverpool University Hospital, Liverpool, UK
| | - Bertil E Damato
- Oxford Eye Hospital and Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Sarah E Coupland
- Liverpool Ocular Oncology Research Group, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Cellular Pathology, Liverpool Clinical Laboratories, Royal Liverpool University Hospital, Liverpool, UK
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Wierenga APA, Cao J, Luyten GPM, Jager MJ. Immune Checkpoint Inhibitors in Uveal and Conjunctival Melanoma. Int Ophthalmol Clin 2019; 59:53-63. [PMID: 30908279 DOI: 10.1097/iio.0000000000000263] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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