Ocular abnormalities associated with cutaneous melanoma and vitiligolike leukoderma

Progression of Cutaneous Vitiligo in a Patient with Large Posterior Choroidal Melanoma: A Case Report

<b><i>Background/Aims:</i></b> The aim of our study was to report a case of progression of cutaneous vitiligo after large posterior choroidal melanoma diagnosis. <b><i>Methods:</i></b> The clinical history, fundus findings and histopathological features suggest the diagnosis of cutaneous vitiligous progression after a diagnosis of large posterior choroidal melanoma. <b><i>Results:</i></b> A 30-year-old female, with a personal history of cutaneous vitiligo for 12 years, was diagnosed with choroidal melanoma 18 months previously. The cutaneous vitiligo had progressed over her back, body and arms during the preceding 3 years. She refused treatment because she was in her 28th week of pregnancy. When she came to our clinic her visual symptoms had worsened, and the fundus examination showed a melanocytic choroidal mass. After confirming that there was no extraocular extension, she was treated with enucleation. A histopathological study confirmed the choroidal melanoma diagnosis. <b><i>Conclusion:</i></b> The association between the progression of vitiligo and the diagnosis of uveal melanoma could be considered a good prognostic factor, as has been described in cases of cutaneous melanoma. A longer follow-up of these patients will allow us to confirm this association.

Birdshot chorioretinopathy

PURPOSE

To ascertain the clinical features and long-term visual prognosis of birdshot chorioretinopathy (BCR), and to identify patients at risk of visual loss.

DESIGN

Retrospective noncomparative case series.

PARTICIPANTS

Fifty-five consecutive patients with HLA-A29-positive BCR who were identified in ophthalmology departments of the University Medical Center of Utrecht and The Eye Hospital Rotterdam, of whom 37 were observed for at least 5 years.

INTERVENTION

A review of the medical and photographic and/or angiographic records of 55 patients with HLA-A29-positive BCR.

MAIN OUTCOME MEASURES

Numerous variables were compared, including age and gender distribution, onset and course of BCR, ocular manifestations, therapeutic strategies and their outcomes, complications, systemic diseases, visual acuity (VA), and features associated with poor visual outcome.

RESULTS

Loss of VA was gradual; the number of affected eyes with VA less than 20/200 increased from 9 of 108 (8%) at onset to 22 of 73 (30%) at 5 years and 19 of 49 (39%) at 10 years of follow-up. The cause of compromised VA was predominantly macular edema and macular atrophy (42 of 55 [76% of cases]). We found strong associations between the VA at onset and visual outcome after 5 and 10 years (P = 0.005 and P = 0.006, respectively). Mean VA at the 5-year follow-up was significantly lower if macular leakage was observed on angiography (P<0.001). No differences in annual loss of VA were observed between patients treated by standard therapeutic modalities and untreated patients.

CONCLUSION

The visual prognosis of BCR in a spectrum of uveitis is poor, and the recommended therapeutic regimens have had no effect on long-term visual prognosis. New treatment strategies are needed for this blinding disorder.

Vogt-Koyanagi-Harada syndrome associated with cutaneous malignant melanoma: an 11-year follow-up

PURPOSE

To report a case of Vogt-Koyanagi-Harada (VKH) syndrome associated with cutaneous pigmented malignant melanoma (MM) and non-pigmented nodular metastasis after a 10-year recurrence-free interval.

METHODS

Case report with long-term follow-up of 11 years. Ocular examinations included best-corrected visual acuity (ETDRS charts), fundus photography, fluorescein angiography, and computer-assisted perimetry. In addition, human leukocyte antigen (HLA) typing was performed.

RESULTS

A 48-year-old white female patient developed VKH disease 5 years after she had undergone surgical treatment of a superficial spreading melanoma on her back in 1991. The first symptoms were diffuse alopecia followed by growth of non-pigmented hair after 8 months. In our clinic, she presented 18 months later with cells and opacification in the vitreous, a macular and optic disc edema and atrophy of the retinal pigment epithelium (RPE). The anterior segment showed endothelial precipitates of the cornea, and a progressive secondary cataract. Fluorescein angiography detected a bilateral edema of the macula and the optic disc, and focal leakage in the RPE level. During follow-up the patient developed more cutaneous signs, such as vitiligo-like depigmentation and poliosis. A non-pigmented lymph node MM metastasis was diagnosed after a 10-year disease-free interval. HLA typing was positive for HLA-A*01, HLA-A*24, HLA-B*08, HLA-B*39, HLA-DRB1*03, and HLADRB1*11.

CONCLUSION

Our findings suggest that the described ocular findings of VKH disease may represent a component of a syndrome consisting also of melanoma-associated hypopigmentation. Within the framework of current concepts of immunity in patients with MM and VKH, the long recurrence-free interval might support the hypothesis of an autoimmune or hypersensitivity process against melanocytes. The use of immunosuppressive therapy in the treatment of VKH and its potential influence on the development of metastatic disease should be carefully reconsidered.