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Dec M, Arasiewicz H. Paraneoplastic syndromes in patients with melanoma. Postepy Dermatol Alergol 2024; 41:251-261. [PMID: 39027696 PMCID: PMC11253314 DOI: 10.5114/ada.2024.141114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/02/2024] [Indexed: 07/20/2024] Open
Abstract
Paraneoplastic syndromes are a group of rare clinical conditions characterized by a diverse array of systemic manifestations that arise in association with malignant tumours, often due to the production of bioactive substances by the tumour or an autoimmune response to the tumour. Melanoma, a malignant skin neoplasm originating from melanocytes, has been associated with various paraneoplastic syndromes. This paper provides an overview of the key paraneoplastic syndromes observed in patients with melanoma. Paraneoplastic syndromes in melanoma can manifest with neurological, dermatological, endocrine, haematological, and rheumatological symptoms, among others. Melanoma-associated retinopathy was the most reported paraneoplastic syndrome; this entity is characterized by a spectrum of retinal abnormalities. Paraneoplastic neurological syndromes, such as paraneoplastic encephalitis and paraneoplastic cerebellar degeneration, are among the most frequently reported. The pathophysiology of paraneoplastic syndromes often involves the production of autoantibodies against neuronal or tumour antigens, immune-mediated reactions, or the release of cytokines and growth factors from the tumour. Management strategies for paraneoplastic syndromes associated with melanoma primarily focus on treating the underlying malignancy, which may lead to resolution or improvement of the paraneoplastic manifestations. Immune-modulating therapies, including corticosteroids, intravenous immunoglobulins, and plasmapheresis, may be considered in selected cases to ameliorate symptoms and suppress the autoimmune response. In conclusion, paraneoplastic syndromes in patients with melanoma are a complex and diverse group of clinical entities with a broad range of presentations. Further research is needed to enhance our understanding of the mechanisms and therapeutic options for paraneoplastic syndromes associated with melanoma.
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Affiliation(s)
- Michał Dec
- Department of Dermatology and Vascular Anomalies, John Paul II Centre of Paediatrics, Sosnowiec, Poland
| | - Hubert Arasiewicz
- Department of Dermatology and Vascular Anomalies, John Paul II Centre of Paediatrics, Sosnowiec, Poland
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Weppelmann TA, Khalil S, Zafrullah N, Amir S, Margo CE. Ocular Paraneoplastic Syndromes: A Critical Review of Diffuse Uveal Melanocytic Proliferation and Autoimmune Retinopathy. Cancer Control 2022; 29:10732748221144458. [PMID: 36473045 PMCID: PMC9732803 DOI: 10.1177/10732748221144458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Dozens of paraneoplastic syndromes affect the visual system ranging from conjunctival pemphigoid to encephalopathy of the occipital cortex. The most profiled ocular syndromes are bilateral diffuse uveal melanocytic proliferation (BDUMP) and the autoimmune retinopathies.Purpose: To review the critical features of these 2 entities then concentrate on advancements in treatment made within the last 10 years.Study Design: Literature review with structured data abstraction.Results: Major insights into pathogenesis have been wanting. Plasmapheresis appears to improve vision in a substantial proportion of patients with BDUMP. The number of clinical variables that influence visual outcome in paraneoplastic retinopathies combined with the variety of local and systemic treatment options makes interpretation of clinical effectiveness difficult.Conclusions: The rarity of these disorders makes randomized clinical trials unlikely. It may be time for a clinical professional organization to use a modified Delphi method to establish a consensus algorithm for the diagnosis and management of retinal paraneoplastic syndromes to augment clinical communications and clinical trials.
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Affiliation(s)
- Thomas A. Weppelmann
- Departments of Ophthalmology,
Morsani
College of Medicine, University of South
Florida, Tampa, FL, USA
| | - Sabrina Khalil
- Departments of Ophthalmology,
Morsani
College of Medicine, University of South
Florida, Tampa, FL, USA
| | - Nabeel Zafrullah
- Departments of Ophthalmology,
Morsani
College of Medicine, University of South
Florida, Tampa, FL, USA
| | - Sabah Amir
- Departments of Ophthalmology,
Morsani
College of Medicine, University of South
Florida, Tampa, FL, USA
| | - Curtis E. Margo
- Departments of Ophthalmology,
Morsani
College of Medicine, University of South
Florida, Tampa, FL, USA,Departments of Pathology and
Molecular Biology, Morsani College of Medicine, University of
South Florida, Tampa, FL, USA,Curtis E. Margo, MD, MPH, Departments of
Ophthalmology, Morsani College of Medicine, University of South Florida, 13330
USF Laurel Dr, Morsani Building 4th Floor Dermatopathology, Tampa, FL 33612,
USA.
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Parrado-Carrillo A, Alcubierre R, Camós-Carreras A, Sanchez-Dalmau BF. Paraneoplastic syndromes in ophthalmology. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:350-357. [PMID: 35292226 DOI: 10.1016/j.oftale.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/03/2021] [Indexed: 06/14/2023]
Abstract
Paraneoplastic syndromes consist on systemic manifestations associated with certain cancers which are not a direct consequence of tumor invasion or its metastases. It is known that autoimmunity and autoantibody synthesis play an important role in its pathophysiology due to a process of molecular mimicry. Paraneoplastic syndromes in ophthalmology are rare, but it is important to recognize them clinically because in some cases symptoms preceded the diagnosis of an underlying neoplasia. Most frequently involved cancer is small cell lung carcinoma, but there is also a relationship with other tumor etiologies such as thymoma, gynecological tumors or neuroblastoma in children. Paraneoplastic syndromes with ocular involvement can be divided into those that affect the afferent visual pathway, such as cancer-associated retinopathy, melanoma-associated retinopathy, or paraneoplastic optic neuropathy; and the ones that affect the efferent visual pathway, such as bilateral tonic pupils, Myasthenia Gravis, Lambert-Eaton syndrome or paraneoplastic cerebellar degeneration. The presence of autoantibodies is helpful in clinical practice but negativity does not exclude this diagnosis. Although evolution and prognosis is linked to primary disease, in some cases specific treatment, usually immunosuppressive therapy, can help improving patients quality of life.
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Affiliation(s)
- A Parrado-Carrillo
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
| | - R Alcubierre
- Complex Hospitalari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain
| | - A Camós-Carreras
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain
| | - B F Sanchez-Dalmau
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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Kim MS, Hong HK, Ko YJ, Park KH, Ueno S, Okado S, Woo SJ, Joo K. A case of melanoma-associated retinopathy with autoantibodies against TRPM1. Doc Ophthalmol 2020; 141:313-318. [PMID: 32472235 DOI: 10.1007/s10633-020-09772-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To report a case of melanoma-associated retinopathy (MAR) with autoantibodies against the transient receptor potential cation channel, subfamily M, member 1 (TRPM1) with asymmetric severe vision loss. METHODS We evaluated a patient with heel skin melanoma showing progressive vision loss in both eyes confirmed with a baseline ophthalmic examination, fluorescein angiography, spectral domain optical coherence tomography (OCT), visual field test, and full-field electroretinogram (ERG). Immunofluorescence assays and western blot analysis revealed autoantibodies in the patient's serum. RESULTS The patient's best-corrected visual acuities were 20/50 in the right eye and hand motion in the left eye. Visual field test showed severely depressed visual fields especially in the left eye. Fluorescein angiography and OCT revealed extrafoveal choroidal neovascularization in the left eye. The patient had an electronegative ERG, suggesting MAR, and autoantibodies against TRPM1 and aldolase C were detected in the patient's blood sample. CONCLUSIONS The clinical features of MAR patients with positive anti-TRPM1 autoantibodies can be manifested as severe vision loss, and the identification of autoantibodies can be helpful for confirming the diagnosis.
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Affiliation(s)
- Min Seok Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Hye Kyoung Hong
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - You Jin Ko
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Shinji Ueno
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Okado
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Kwangsic Joo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
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Ocular Paraneoplastic Syndromes. Biomedicines 2020; 8:biomedicines8110490. [PMID: 33182708 PMCID: PMC7698240 DOI: 10.3390/biomedicines8110490] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/28/2020] [Accepted: 11/08/2020] [Indexed: 12/12/2022] Open
Abstract
Ocular-involving paraneoplastic syndromes present a wide variety of clinical symptoms. Understanding the background pathophysiological and immunopathological factors can help make a more refined differential diagnosis consistent with the signs and symptoms presented by patients. There are two main pathophysiology arms: (1) autoimmune pathomechanism, which is presented with cancer-associated retinopathy (CAR), melanoma-associated retinopathy (MAR), cancer-associated cone dysfunction (CACD), paraneoplastic vitelliform maculopathy (PVM), and paraneoplastic optic neuritis (PON), and (2) ectopic peptides, which is often caused by tumor-expressed growth factors (T-exGF) and presented with bilateral diffuse uveal melanocytic proliferation (BDUMP). Meticulous systematic analysis of patient symptoms is a critical diagnostic step, complemented by multimodal imaging, which includes fundus photography, optical coherent tomography, fundus autofluorescence, fundus fluorescein angiography, electrophysiological examination, and sometimes fundus indocyjanin green angiography if prescribed by the clinician. Assessment of the presence of circulating antibodies is required for diagnosis. Antiretinal autoantibodies are highly associated with visual paraneoplastic syndromes and may guide diagnosis by classifying clinical manifestations in addition to monitoring treatment.
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Richarz NA, Quirant Sanchez B, Gomez Sanchez S, Cobos Martin E, Manzano Mozo JL, Boada Garcia A. Melanoma‐associated retinopathy: Photopsias as a first sign of melanoma progression? Australas J Dermatol 2020; 61:70-72. [DOI: 10.1111/ajd.13134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Nina A. Richarz
- Department of Dermatology Hospital Universitari Germans Trias i Pujol Universitat Autònoma de Barcelona Badalona, Barcelona Spain
| | - Bibiana Quirant Sanchez
- Department of Immunology Hospital Universitari Germans Trias i Pujol Universitat Autònoma de Barcelona Badalona, Barcelona Spain
| | - Sandra Gomez Sanchez
- Department of Ophthalmology Hospital Universitari Germans Trias i Pujol Universitat Autònoma de Barcelona Badalona, Barcelona Spain
| | - Estefania Cobos Martin
- Department of Ophthalmology L'Hospitalet de Llobregat Hospital Universitari de Bellvitge. Universitat de Barcelona Barcelona Spain
| | - Jose Luis Manzano Mozo
- Department of Medical Oncology Institut Catalá d’ Oncologia (ICO) Badalona, Barcelona Spain
| | - Aram Boada Garcia
- Department of Dermatology Hospital Universitari Germans Trias i Pujol Universitat Autònoma de Barcelona Badalona, Barcelona Spain
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