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Cherkas E, Kalafatis NE, Marous MR, Shields CL. Iris melanoma: Review of clinical features, risks, management, and outcomes. Clin Dermatol 2024; 42:62-70. [PMID: 37865279 DOI: 10.1016/j.clindermatol.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Primary uveal melanoma is rare and affects approximately 8,000 persons per year worldwide. This malignancy can involve the iris, ciliary body, and choroid. Of these three structures, the iris is the least commonly affected site, representing only 4% of all uveal melanomas. Iris melanoma can arise from iris melanocytic nevus, iris melanocytosis, or de novo. In a longitudinal study of 1,611 patients with iris nevus, transformation into melanoma, using Kaplan-Meier estimates, was found in 2.6% by five years and in 4.1% by 10 years. The factors that predicted growth of iris melanocytic nevus into melanoma are denoted by a letter (ABCDEF) guide: A for age ≤40 years old at presentation (hazard ratio [HR] = 3, P = .01), B for blood (hyphema) (HR = 9, P < .0004), C for clock hour of tumor inferiorly (tumor location) (HR = 9, P = .03), D for diffuse flat tumor configuration (HR = 14, P = .02), E for ectropion uveae (HR = 4, P = .002), and F for feathery ill-defined margins (HR = 3, P = .02). At diagnosis, iris melanoma has a mean cross-sectional diameter of 5.5 mm and thickness of 2.1 mm, often with tumor seeding (28%) and secondary glaucoma (35%). We provide a comprehensive review of iris nevus and melanoma to explore relevant demographic and clinical data, risk factors for tumor growth, management, and prognosis, with the hope that clinicians will be more comfortable in understanding this rare malignant condition.
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Affiliation(s)
- Elliot Cherkas
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nicholas E Kalafatis
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Molly R Marous
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York, USA
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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Eibenberger K, Heimann H, Gatchalian L, Kacperek A, Hussain R. Side Effects of Proton Beam Radiotherapy Treatment on Iris Melanoma. Ophthalmology 2023; 130:958-965. [PMID: 37169262 DOI: 10.1016/j.ophtha.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/07/2023] [Accepted: 05/03/2023] [Indexed: 05/13/2023] Open
Abstract
PURPOSE This study evaluated the functional outcome and ocular side effects of patients receiving proton beam radiotherapy (PBR) for the treatment of iris melanoma (IM). DESIGN This retrospective study analyzed prospectively collected data. PARTICIPANTS Patients with IM who underwent PBR as a primary treatment. METHODS Treatment was given in the form of whole PBR (wPBR: n = 51) or segmental PBR (sPBR: n = 98). MAIN OUTCOME MEASURES Visual acuity (VA) and side effects were divided into ocular surface disease (OSD), secondary glaucoma, or cataract development. RESULTS A total of 149 eyes of 149 patients with a mean age of 53.9 ± 16.0 years were included. Tumor recurrence developed in 3 patients (wPBR: 1/51; sPBR: 2/98). Ocular surface disease was observed in 78.4% of the wPBR group (40/51) and 25.5% of the sPBR group (25/98) (P < 0.001) after 0.7 ± 1.2 years and 1.1 ± 0.9 years, respectively. The main side effect was dry eye syndrome in both groups, but severe side effects such as limbal stem cell failure were found only in the wPBR group (4/51; 7.8%). Secondary glaucoma developed in 31.4% of the wPBR group (16/51) compared with 1.0% in the sPBR group (1/98; P < 0.001). Glaucoma control was generally achieved with eye drops, whereas surgery was necessary in 5 patients (wPBR: 4/51, 7.8%; sPBR: 1/98, 1%). Cataract surgery was performed in 47.9% of the wPBR group (23/48) and 19.8% of the sPBR group (19/96) (P < 0.001). Before treatment, VA was 0.14 ± 0.27 logarithm of the minimum angle of resolution (logMAR) in the wPBR group and 0.04 ± 0.19 logMAR in the sPBR group. A worsening was seen in the wPBR group (0.55 ± 0.16 logMAR; P < 0.001) 6 months after radiotherapy, which normalized after 12 months (0.15 ± 0.30 logMAR; P = 0.17). In the sPBR group, no such decrease in VA was observed (6 months: 0.03 ± 0.22 logMAR, P = 0.54; 12 months: 0.04 ± 0.21 logMAR, P = 0.98). CONCLUSIONS Our results demonstrate that PBR is a very successful treatment option for patients with IM, showing a high tumor control rate and relatively low complication profile. Tumor recurrence was a rare event, and secondary enucleation was not necessary in any patient. Side effects are commonly seen, but severe side effects such as limbal stem cell failure or secondary glaucoma mainly developed after wPBR. These results are important for clinical decision making and discussion with the patient regarding this form of radiotherapy. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Katharina Eibenberger
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals Trust, Liverpool, United Kingdom
| | - Heinrich Heimann
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals Trust, Liverpool, United Kingdom; Liverpool Ocular Oncology Research Group, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Leandro Gatchalian
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals Trust, Liverpool, United Kingdom
| | - Andrzej Kacperek
- The Clatterbridge Cancer Centre, Bebington, Wirral, United Kingdom
| | - Rumana Hussain
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals Trust, Liverpool, United Kingdom; Liverpool Ocular Oncology Research Group, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom.
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Shukla AG, Vaidya S, Yaghy A, Di Nicola M, Kaliki S, Fulco E, Myers JS, Shields JA, Shields CL. Iris melanoma: factors predictive of post-management secondary glaucoma in 271 cases at a Single Ocular Oncology Centre. Eye (Lond) 2023; 37:938-946. [PMID: 35383310 PMCID: PMC10050146 DOI: 10.1038/s41433-022-02051-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/26/2022] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND/AIMS To identify factors predictive of post-management secondary glaucoma in eyes with iris melanoma. METHODS Patients with iris melanoma who were conservatively managed on the Ocular Oncology Service, Wills Eye Hospital from 1970 to 2016 were included. Charts were retrospectively reviewed, and binary logistic regression analysis was performed. Main outcome measures were factors predictive of post-management glaucoma, defined as intraocular pressure (IOP) > 22 mmHg following melanoma treatment. RESULTS Of 271 patients with iris melanoma, melanoma-related glaucoma was identified in 40 (15%) at presentation and post-management glaucoma developed in 75 (28%) at a mean of 103.7 months (range:1.0-120.0). Comparison (post-management glaucoma vs. no glaucoma) revealed patients with post-management glaucoma presented with worse visual acuity (20/50-20/150) (17% vs. 5%, p = 0.001), increased mean tumour basal diameter (5.1 mm vs. 4.3 mm, p = 0.004), greater melanoma-related increased IOP on presentation (24.1 mmHg vs. 16.2 mmHg, p < 0.001), diffuse tumour shape (9% vs. 4%, p = 0.01), American Joint Committee on Cancer (AJCC) T4 category (7% vs. 2%, p = 0.03), and extraocular tumour extension (7% vs. 2%, p = 0.03). Risk factors for post-management glaucoma identified by multivariate analysis included melanoma-related increased IOP at presentation (OR:1.1, [1.08-1.22] per 1-mmHg increase, p < 0.001), increased mean tumour basal diameter (OR:1.17, [1.02-1.33] per 1-millimetre increments, p = 0.03), advanced AJCC clinical T subcategory (OR:1.23, [1.04-1.46] per 1-subcategory increments, p = 0.02) and plaque radiotherapy treatment (OR:2.32, [1.13-4.75], p = 0.02). CONCLUSION Features of iris melanoma that predicted post-management glaucoma included melanoma-related increased IOP on presentation, advanced AJCC clinical T subcategory, increased mean tumour basal diameter, and plaque radiotherapy treatment.
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Affiliation(s)
- Aakriti Garg Shukla
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 11th Floor, Philadelphia, PA, 19107, USA.
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA.
| | - Sarangdev Vaidya
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107, USA
| | - Antonio Yaghy
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107, USA
| | - Maura Di Nicola
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107, USA
| | - Swathi Kaliki
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107, USA
| | - Enzo Fulco
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107, USA
| | - Jonathan S Myers
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 11th Floor, Philadelphia, PA, 19107, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Jerry A Shields
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107, USA
| | - Carol L Shields
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107, USA
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Iris melanocytic tumours in New Zealand/Aotearoa: presentation, management and outcome in a high UV exposure environment. Eye (Lond) 2023; 37:692-699. [PMID: 35338357 PMCID: PMC9998588 DOI: 10.1038/s41433-022-02017-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/09/2022] [Accepted: 03/04/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/OBJECTIVES Iris melanoma, a rare intraocular malignancy, represents the smallest subgroup of uveal melanoma. This first, comprehensive study of iris melanocytic lesions in the high ultraviolet environment in New Zealand/ Aotearoa (NZ) examines diagnosis, management and outcomes. SUBJECTS/METHODS Retrospective study of iris melanocytic tumours referred to tertiary referral centres in Auckland, NZ, over 20 years (1999-2018). Data analysed include demographics, tumour characteristics, histology, genetic analyses, treatment modalities, recurrence, metastasis, 5-year and overall survival. RESULTS Cohort (N = 51) was predominantly NZ European (98.0%) with no indigenous Māori, or Pasifika. Median age at presentation was 58 years. Tumours involved a median of two clock hours of iris. The posterior tumour margin extended to the anterior chamber angle in 22 patients (45.8%). Management included initial observation 54.9%, iridectomy/excision biopsy 29.4%, irido-cyclectomy 7.8%, plaque radiotherapy 7.8%, proton beam radiotherapy 7.8%, and ultimately enucleation 17.6%. Histology was performed in 19 cases (37%) with 16 confirmed melanomas (84%). Mean follow-up 4.2 years with median visual acuity of 6/7.5 two years post intervention. Melanoma-related metastasis and mortality occurred in two cases with five-year melanoma-related mortality of 2.0%. CONCLUSION In a climate with high ultraviolet exposure iris melanocytic tumours occurred almost exclusively in NZ Europeans, however, the majority of cases were category T1, possibly reflecting early diagnosis in the NZ health system. Nonetheless, >50% underwent surgery or radiotherapy, often utilising more than one modality. A high index of suspicion and early referral of iris melanocytic lesions should be considered in regions with high UV exposure.
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Hopkins NS, Kornblau IS, Montes-Sabino CE, Boom A, Wilson MW. Delayed recurrence of an iridociliary malignant melanoma 180° from the primary tumor. Am J Ophthalmol Case Rep 2022; 28:101710. [PMID: 36262689 PMCID: PMC9574778 DOI: 10.1016/j.ajoc.2022.101710] [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: 04/28/2021] [Revised: 09/05/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose We report the case of a 66-year-old female who returned with a rare recurrence of iridociliary melanoma 180° from the original lesion. Observations Upon initial presentation eleven years prior, a pigmented iris lesion suspicious for primary uveal melanoma was noted in the right eye at 9 o'clock. After one year of observation, inferior growth of the iris lesion prompted treatment via primary iridectomy with excisional biopsy and pupilloplasty. Postoperative biopsy confirmed spindle B type melanoma with epithelial foci, and adjuvant brachytherapy was performed to treat the reported positive anterior ciliary body involvement. Ten years after initial plaque brachytherapy treatment, the patient returned with a pigmented iris lesion in the right eye at 3:30–5 o'clock, which was treated with enucleation. On pathology, the new melanoma was predominantly epithelioid, consistent with a transformed recurrent iridociliary melanoma. The patient remains metastasis free 13 years after initial diagnosis. Conclusions and importance This case describes a rare, late recurrence of an iridociliary melanoma 180° away eleven years after initial presentation, emphasizing the importance of lifelong follow-up for patients with iridociliary melanoma. This rare form of recurrence has not been previously reported in the literature. We hypothesize the original lesion contained radiotherapy resistant epithelioid cells which grew superficially on the posterior iris and anterior ciliary body, ultimately breaking back through the anterior iris 180° away.
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Affiliation(s)
- Nikolas S. Hopkins
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ilyse S. Kornblau
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA,Department of Surgical Services, Ophthalmology Section, Veterans Health Administration, Memphis, TN, USA,Corresponding author. Department of Ophthalmology Hamilton Eye Institute, University of Tennessee Health Science, Center 930 Madison Ave Memphis, TN, 38103, United States.
| | - Christopher E. Montes-Sabino
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Alan Boom
- Department of Pathology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Matthew W. Wilson
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
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Xu TT, Pulido JS, Deufel CL, Corbin KS, Petersen IA, Dalvin LA. Clinical outcomes of Modified Collaborative Ocular Melanoma Study IRIS plaques for treatment of iris, iridociliary, and ciliary body melanoma. Eye (Lond) 2021; 35:2754-2762. [PMID: 33235338 PMCID: PMC8452726 DOI: 10.1038/s41433-020-01295-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND/OBJECTIVES To report clinical outcomes of modified Collaborative Ocular Melanoma Study IRIS (COMS IRIS) plaques for treatment of iris, iridociliary, and ciliary body melanoma. SUBJECTS/METHODS Retrospective, single-centre cohort study of iris melanoma treated with COMS IRIS plaque radiotherapy from July 26, 2010 to October 15, 2018. Medical records were reviewed for demographics, tumour features, treatment parameters, and clinical outcomes. RESULTS There were 22 cases, diagnosed at mean age of 59 years (median 65, range 21-85 years) with female sex in 14 (64%). Presenting tumour features included Snellen visual acuity (VA) ≥ 20/40 in 18 (82%) cases, mean largest tumour basal diameter 4.7 mm (median 3.9, range 2.3-13.8 mm) and thickness 1.7 mm (median 1.6 mm, range 0.8-3.9 mm), iris stromal seeding in 3 (14%) cases, angle seeding in 16 (73%), and ciliary body involvement in 13 (59%). After mean follow-up of 51 months (median 44, range 4-113 months), Snellen VA was ≥20/40 in 14 (64%) cases, with local tumour recurrence in 2 (9%), and enucleation in 2 (9%). The 3-year Kaplan-Meier estimated risk of local tumour recurrence was 7%. The most common radiation side effects were cataract in 17 (77%) patients and dry eye in 5 (23%). Systemic metastasis occurred in no cases, and 1 (5%) non-melanoma-related death due to natural causes was observed at last follow-up. CONCLUSIONS COMS IRIS plaques are effective for treatment of iris, iridociliary, and ciliary body melanoma with modest VA outcomes and low frequency of local tumour recurrence, enucleation, radiation side effects, and systemic metastasis.
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Affiliation(s)
- Timothy T. Xu
- grid.66875.3a0000 0004 0459 167XAlix School of Medicine, Mayo Clinic, Rochester, MN USA
| | - Jose S. Pulido
- grid.66875.3a0000 0004 0459 167XDepartment of Ophthalmology, Mayo Clinic, Rochester, MN USA
| | - Christopher L. Deufel
- grid.66875.3a0000 0004 0459 167XDepartment of Radiation Oncology, Mayo Clinic, Rochester, MN USA
| | - Kimberly S. Corbin
- grid.66875.3a0000 0004 0459 167XDepartment of Radiation Oncology, Mayo Clinic, Rochester, MN USA
| | - Ivy A. Petersen
- grid.66875.3a0000 0004 0459 167XDepartment of Radiation Oncology, Mayo Clinic, Rochester, MN USA
| | - Lauren A. Dalvin
- grid.66875.3a0000 0004 0459 167XDepartment of Ophthalmology, Mayo Clinic, Rochester, MN USA
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Brachytherapy or enucleation in ring melanoma patients: which is better? Preliminary results of the authors' own experiences. J Contemp Brachytherapy 2021; 13:433-440. [PMID: 34484358 PMCID: PMC8407261 DOI: 10.5114/jcb.2021.108598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/16/2021] [Indexed: 02/03/2023] Open
Abstract
Purpose A retrospective evaluation of effectiveness of brachytherapy or enucleation in treatment of rare form of uveal melanoma: ring melanoma. Material and methods Analysis comprised 49 patients treated from 2000 to 2019 for ring melanoma involving ciliary body. In 15 patients, primary treatment consisted of brachytherapy (106Ru or 125I), whereas in 34 patients, eyeballs were enucleated. The evaluation concerned differences between analyzed groups relating to the clinical and histopathological features as well as overall survival, cancer-specific overall survival, and disease-free survival. Results No significant differences between the analyzed groups were found with regards to clinical and histopathological features, apart from intra-ocular pressure (increased in the enucleation group). Kaplan-Meier analysis did not reveal any significant differences between the group treated with enucleation and the group undergoing brachytherapy, both with regards to overall survival (p = 0.325) and cancer-specific overall survival (p = 0.477). A significant difference was observed in disease-free survival (p = 0.009), which was significantly shorter in the group undergoing brachytherapy. In the analysis of parameters of the applied brachytherapy, no significant differences between patients with and without local recurrence were found. Mean observation period was 350.8 weeks (range, 24-996 weeks, SD = 231.6). A local recurrence occurred in 11 (22.4%) patients, including 3 (6.1%) in enucleation and 8 (16.3%) after brachytherapy groups. Metastasis developed in 11 (22.4%) cases after a mean follow-up of 133 weeks (33.25 months), range 3-655 weeks. Conclusions Preliminary observations may suggest that brachytherapy in this rare form of uveal melanoma, such as ring melanoma involving the ciliary body, may be taken into consideration as a useful alternative to enucleation. However, the confirmation of such an approach requires a larger patients’ group to be gathered, and also a longer follow-up period. This is especially important in patients with a good baseline visual acuity in the affected eye, or when the neoplasm is present in the remaining eye with vision.
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Jin Y, Wang Z, He D, Zhu Y, Gong L, Xiao M, Chen X, Cao K. Analysis of Ferroptosis-Mediated Modification Patterns and Tumor Immune Microenvironment Characterization in Uveal Melanoma. Front Cell Dev Biol 2021; 9:685120. [PMID: 34386492 PMCID: PMC8353259 DOI: 10.3389/fcell.2021.685120] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/24/2021] [Indexed: 12/15/2022] Open
Abstract
Uveal melanoma (UVM) is an intraocular malignancy in adults in which approximately 50% of patients develop metastatic disease and have a poor prognosis. The need for immunotherapies has rapidly emerged, and recent research has yielded impressive results. Emerging evidence has implicated ferroptosis as a novel type of cell death that may mediate tumor-infiltrating immune cells to influence anticancer immunity. In this study, we first selected 11 ferroptosis regulators in UVM samples from the training set (TCGA and GSE84976 databases) by Cox analysis. We then divided these molecules into modules A and B based on the STRING database and used consensus clustering analysis to classify genes in both modules. According to the Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Gene Set Enrichment Analysis (GSEA), the results revealed that the clusters in module A were remarkably related to immune-related pathways. Next, we applied the ESTIMATE and CIBERSORT algorithms and found that these ferroptosis-related patterns may affect a proportion of TME infiltrating cells, thereby mediating the tumor immune environment. Additionally, to further develop the prognostic signatures based on the immune landscape, we established a six-gene-regulator prognostic model in the training set and successfully verified it in the validation set (GSE44295 and GSE27831). Subsequently, we identified the key molecules, including ABCC1, CHAC1, and GSS, which were associated with poor overall survival, progression-free survival, disease-specific survival, and progression-free interval. We constructed a competing endogenous RNA network to further elucidate the mechanisms, which consisted of 29 lncRNAs, 12 miRNAs, and 25 ferroptosis-related mRNAs. Our findings indicate that the ferroptosis-related genes may be suitable potential biomarkers to provide novel insights into UVM prognosis and decipher the underlying mechanisms in tumor microenvironment characterization.
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Affiliation(s)
- Yi Jin
- Department of Oncology, Third Xiangya Hospital of Central South University, Changsha, China.,Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.,Department of Radiation Oncology, Hunan Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Zhanwang Wang
- Department of Oncology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Dong He
- Department of Respiratory, The Second People's Hospital of Hunan Province, Changsha, China
| | - Yuxing Zhu
- Department of Oncology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Lian Gong
- Department of Oncology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Mengqing Xiao
- Department of Oncology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Xingyu Chen
- Department of Oncology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Ke Cao
- Department of Oncology, Third Xiangya Hospital of Central South University, Changsha, China
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Abstract
PURPOSE OF REVIEW To review recent advancements in the genetic understanding, diagnosis, prognosis, and treatment of uveal melanoma (UM). RECENT FINDINGS UM is a molecularly distinct melanocytic malignancy driven by mutations in GNAQ or GNA11, with mitogen-activated protein kinase pathway upregulation. Earlier diagnosis and treatment are important factors for improving life prognosis. These goals can be aided by more objective multimodal imaging risk factors for the prediction of malignant nevus transformation and novel treatment strategies such as customized radiation fields and nanoparticle therapy to reduce vision-threatening treatment side effects. The risk for metastatic disease can be reliably predicted through gene expression profiling or the Cancer Genome Atlas project classification, and combined use of clinical tumor features with molecular data allows for highly individualized patient prognosis. Patients with high-risk UM should be considered for clinical trials of adjuvant therapy to prevent metastatic disease. For patients with clinically evident metastasis, combination immunotherapy regimens, T cell-based therapies, and focal adhesion kinase inhibitors offer hope for improved clinical response rates. SUMMARY Improved understanding of UM molecular pathogenesis and clinical trials of targeted therapy for prevention and treatment of metastatic disease may improve patient survival for this challenging disease.
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Schmelter V, Heidorn S, Muacevic A, Priglinger SG, Foerster P, Liegl R. Robotic assisted CyberKnife radiosurgery for the treatment of iris melanoma. Sci Rep 2021; 11:5685. [PMID: 33707492 PMCID: PMC7952409 DOI: 10.1038/s41598-021-84290-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/16/2020] [Indexed: 11/09/2022] Open
Abstract
Iris melanoma is a rare form of uveal melanoma with potential metastic spread. Treatment options include surgical resection, enucleation or irradiation. We analysed visual outcome, complication appearance and management in eight patients with iris melanoma following robotic-assisted CyberKnife treatment. Consecutive patients from the Department of Ophthalmology at University of Munich were included in the study if they had an iris melanoma that was treated with CyberKnife and had a minimum follow-up of 12 months. We evaluated tumor thickness, largest diameter, visual acuity and complications. 8 patients were included in this report. The median age was 74 years (range: 53-86 years). The median follow-up was 23 months (range 12-48 months). Tumor thickness decreased from 2.1 to 1.4 mm on average. Four out of eight patients showed stable or increased visual acuity compared to visual acuity at first visit. We did not find a correlation of applied radiation volume or radiation dose on visual outcome. Radiation keratopathy was the most common complication in five patients. No recurrences were noted. Robotic-assisted radiosurgery following CyberKnife is a promising non-invasive, single session treatment option for iris melanoma with comparable results regarding recurrence rate or complications to brachytherapy and proton beam therapy. All included patients showed good visual outcome.
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Affiliation(s)
- Valerie Schmelter
- Department of Ophthalmology, Ludwig-Maximilians University Munich, Mathildenstr. 8, 80336, Munich, Germany
| | | | | | - Siegfried G Priglinger
- Department of Ophthalmology, Ludwig-Maximilians University Munich, Mathildenstr. 8, 80336, Munich, Germany
| | - Paul Foerster
- Department of Ophthalmology, Ludwig-Maximilians University Munich, Mathildenstr. 8, 80336, Munich, Germany
| | - Raffael Liegl
- Department of Ophthalmology, Ludwig-Maximilians University Munich, Mathildenstr. 8, 80336, Munich, Germany.
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Fallico M, Raciti G, Longo A, Reibaldi M, Bonfiglio V, Russo A, Caltabiano R, Gattuso G, Falzone L, Avitabile T. Current molecular and clinical insights into uveal melanoma (Review). Int J Oncol 2021; 58:10. [PMID: 33649778 PMCID: PMC7910016 DOI: 10.3892/ijo.2021.5190] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/30/2020] [Indexed: 12/13/2022] Open
Abstract
Uveal melanoma (UM) represents the most prominent primary eye cancer in adults. With an incidence of approximately 5 cases per million individuals annually in the United States, UM could be considered a relatively rare cancer. The 90-95% of UM cases arise from the choroid. Diagnosis is based mainly on a clinical examination and ancillary tests, with ocular ultrasonography being of greatest value. Differential diagnosis can prove challenging in the case of indeterminate choroidal lesions and, sometimes, monitoring for documented growth may be the proper approach. Fine needle aspiration biopsy tends to be performed with a prognostic purpose, often in combination with radiotherapy. Gene expression profiling has allowed for the grading of UMs into two classes, which feature different metastatic risks. Patients with UM require a specialized multidisciplinary management. Primary tumor treatment can be either enucleation or globe preserving. Usually, enucleation is reserved for larger tumors, while radiotherapy is preferred for small/medium melanomas. The prognosis is unfavorable due to the high mortality rate and high tendency to metastasize. Following the development of metastatic disease, the mortality rate increases to 80% within one year, due to both the absence of an effective treatment and the aggressiveness of the condition. Novel molecular studies have allowed for a better understanding of the genetic and epigenetic mechanisms involved in UM biological activity, which differs compared to skin melanomas. The most commonly mutated genes are GNAQ, GNA11 and BAP1. Research in this field could help to identify effective diagnostic and prognostic biomarkers, as well as novel therapeutic targets.
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Affiliation(s)
- Matteo Fallico
- Department of Ophthalmology, University of Catania, I‑95123 Catania, Italy
| | - Giuseppina Raciti
- Department of Drug Sciences, Section of Biochemistry, University of Catania, I‑95125 Catania, Italy
| | - Antonio Longo
- Department of Ophthalmology, University of Catania, I‑95123 Catania, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, I‑10122 Turin, Italy
| | - Vincenza Bonfiglio
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, I‑90127 Palermo, Italy
| | - Andrea Russo
- Department of Ophthalmology, University of Catania, I‑95123 Catania, Italy
| | - Rosario Caltabiano
- Department 'G.F. Ingrassia', Section of Anatomic Pathology, University of Catania, I‑95123 Catania, Italy
| | - Giuseppe Gattuso
- Department of Biomedical and Biotechnological Sciences, University of Catania, I‑95123 Catania, Italy
| | - Luca Falzone
- Epidemiology Unit, IRCCS Istituto Nazionale Tumori 'Fondazione G. Pascale', I‑80131 Naples, Italy
| | - Teresio Avitabile
- Department of Ophthalmology, University of Catania, I‑95123 Catania, Italy
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12
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Plaque brachytherapy in iris and iridociliary melanoma: a systematic review of efficacy and complications. J Contemp Brachytherapy 2021; 13:46-50. [PMID: 34025736 PMCID: PMC8117704 DOI: 10.5114/jcb.2021.103586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/06/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose To evaluate the efficacy and vision-threatening complication rate of plaque brachytherapy with iodine-125 (125I), palladium-103 (103Pd), and ruthenium-106 (106Ru) for treatment of iris and iridociliary melanoma. Material and methods A literature review was done based on results yielded from searching PubMed, Embase, and Cochrane database, using following key words: iris melanoma, iridociliary melanoma, brachytherapy, iodine-125 brachytherapy, palladium-103 brachytherapy, and ruthenium-106 brachytherapy. Initially, relationships between mean radiation dose to apex and local recurrence and complication rate were analyzed, and then, a comparison was performed between 125I, 103Pd, and 106Ru studies. Results Twelve retrospective and prospective studies were selected, with 491 patients treated primarily with plaque brachytherapy. The range of radiation dose to tumor apex were from 84 to 151.5 Gy. Ranges of mean and median of follow-up time were from 27 to 96 months. Local recurrence rate following brachytherapy ranged from 0 to 8%. A decrease in the average study dose was not associated with an increased local recurrence or metastasis rate (p = 0.373 and 0.195, respectively); however, an increase in radiation dose was associated with higher radiation-related cataract and glaucoma (p < 0.05). The rate of post-treatment glaucoma was higher in studies with 125I plaque brachytherapy (p = 0.004). Conclusions For brachytherapy of iris and iridociliary melanoma, in a range of 84 to 150 Gy, an increase in radiation dose may increase the risk of complications, while the tumor control rate does not change.
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13
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Bas Z, Yaghy A, Shields CL. Iris melanoma with neovascularization in sector melanocytosis controlled with 125I plaque radiotherapy and bevacizumab. J Fr Ophtalmol 2021; 44:738-739. [PMID: 33610395 DOI: 10.1016/j.jfo.2020.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/17/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Z Bas
- Ocular Oncology Service, Wills Eye Hospital, Thomas-Jefferson University, 840, Walnut Street, 14th Floor, 19107 Philadelphia, PA, United States
| | - A Yaghy
- Ocular Oncology Service, Wills Eye Hospital, Thomas-Jefferson University, 840, Walnut Street, 14th Floor, 19107 Philadelphia, PA, United States
| | - C L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas-Jefferson University, 840, Walnut Street, 14th Floor, 19107 Philadelphia, PA, United States.
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14
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van Poppelen NM, de Bruyn DP, Bicer T, Verdijk R, Naus N, Mensink H, Paridaens D, de Klein A, Brosens E, Kiliҫ E. Genetics of Ocular Melanoma: Insights into Genetics, Inheritance and Testing. Int J Mol Sci 2020; 22:E336. [PMID: 33396957 PMCID: PMC7795687 DOI: 10.3390/ijms22010336] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/04/2020] [Accepted: 12/24/2020] [Indexed: 12/18/2022] Open
Abstract
Ocular melanoma consists of posterior uveal melanoma, iris melanoma and conjunctival melanoma. These malignancies derive from melanocytes in the uveal tract or conjunctiva. The genetic profiles of these different entities differ from each other. In uveal melanoma, GNAQ and GNA11 gene mutations are frequently found and prognosis is based on mutation status of BAP1, SF3B1 and EIF1AX genes. Iris melanoma, also originating from the uvea, has similarities to the genetic makeups of both posterior uveal melanoma (UM) and conjunctival melanoma since mutations in GNAQ and GNA11 are less common and genes involved in conjunctival melanoma such as BRAF have been described. The genetic spectrum of conjunctival melanoma, however, includes frequent mutations in the BRAF, NRAS and TERT promoter genes, which are found in cutaneous melanoma as well. The BRAF status of the tumor is not correlated to prognosis, whereas the TERT promoter gene mutations are. Clinical presentation, histopathological characteristics and copy number alterations are associated with survival in ocular melanoma. Tissue material is needed to classify ocular melanoma in the different subgroups, which creates a need for the use of noninvasive techniques to prognosticate patients who underwent eye preserving treatment.
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Affiliation(s)
- Natasha M. van Poppelen
- Department of Ophthalmology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (D.P.d.B.); (T.B.); (N.N.); (D.P.)
- Department of Clinical Genetics, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (A.d.K.); (E.B.)
| | - Daniël P. de Bruyn
- Department of Ophthalmology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (D.P.d.B.); (T.B.); (N.N.); (D.P.)
- Department of Clinical Genetics, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (A.d.K.); (E.B.)
| | - Tolga Bicer
- Department of Ophthalmology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (D.P.d.B.); (T.B.); (N.N.); (D.P.)
- Department of Ophthalmology, University of Health Sciences Diskapi Training and Research Hospital, Ankara 06330, Turkey
| | - Rob Verdijk
- Department of Pathology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands;
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Nicole Naus
- Department of Ophthalmology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (D.P.d.B.); (T.B.); (N.N.); (D.P.)
| | - Hanneke Mensink
- Department of Ophthalmic Oncology, The Rotterdam Eye Hospital, 3011 BH Rotterdam, The Netherlands;
| | - Dion Paridaens
- Department of Ophthalmology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (D.P.d.B.); (T.B.); (N.N.); (D.P.)
- Department of Ophthalmic Oncology, The Rotterdam Eye Hospital, 3011 BH Rotterdam, The Netherlands;
| | - Annelies de Klein
- Department of Clinical Genetics, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (A.d.K.); (E.B.)
| | - Erwin Brosens
- Department of Clinical Genetics, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (A.d.K.); (E.B.)
| | - Emine Kiliҫ
- Department of Ophthalmology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (N.M.v.P.); (D.P.d.B.); (T.B.); (N.N.); (D.P.)
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15
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Ocular manifestations in phakomatosis pigmentovascularis: Current concepts on pathogenesis, diagnosis, and management. Surv Ophthalmol 2020; 66:482-492. [PMID: 33058925 DOI: 10.1016/j.survophthal.2020.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 02/03/2023]
Abstract
Phakomatosis pigmentovascularis is a rare congenital multisystemic disease with variable manifestations where a vascular malformation of the skin is associated with a pigmentary nevus. Ocular involvement includes glaucoma, choroidal hemangioma, and pigmentary alterations that predispose to uveal melanoma. Diagnosis is made on clinical grounds, although recent advances in molecular genetics have better clarified the etiopathogenesis of the condition. The advent of improved imaging techniques such as enhanced depth imaging spectral domain optical coherence tomography has provided new insight into the ocular alterations, enabling better follow-up of patients. We review the ophthalmic manifestations of the disease with an update on etiopathogenesis and current management strategies.
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16
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Abstract
Uveal melanoma (UM) is the most common primary intraocular malignancy in adults. UMs are usually initiated by a mutation in GNAQ or GNA11, unlike cutaneous melanomas, which usually harbour a BRAF or NRAS mutation. The annual incidence in Europe and the USA is ~6 per million population per year. Risk factors include fair skin, light-coloured eyes, congenital ocular melanocytosis, ocular melanocytoma and the BAP1-tumour predisposition syndrome. Ocular treatment aims at preserving the eye and useful vision and, if possible, preventing metastases. Enucleation has largely been superseded by various forms of radiotherapy, phototherapy and local tumour resection, often administered in combination. Ocular outcomes are best with small tumours not extending close to the optic disc and/or fovea. Almost 50% of patients develop metastatic disease, which usually involves the liver, and is usually fatal within 1 year. Although UM metastases are less responsive than cutaneous melanoma to chemotherapy or immune checkpoint inhibitors, encouraging results have been reported with partial hepatectomy for solitary metastases, with percutaneous hepatic perfusion with melphalan or with tebentafusp. Better insight into tumour immunology and metabolism may lead to new treatments.
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17
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Abstract
PURPOSE OF REVIEW Glaucoma secondary to intraocular tumors is important to consider in eyes with a known tumor and those with unilateral or refractory glaucoma. The purpose of this review is to discuss the mechanisms and management of intraocular tumors with related secondary glaucoma. RECENT FINDINGS Several intraocular tumors can lead to glaucoma, including iris melanoma, iris metastasis, iris lymphoma, trabecular meshwork melanoma, choroidal melanoma, choroidal metastasis, retinoblastoma, and medulloepithelioma. The mechanisms for glaucoma include solid tumor invasion into the angle, tumor seeding into the angle, angle closure, and iris neovascularization. Management of the tumor can lead to resolution of glaucoma. Management of the secondary glaucoma may involve medical therapy, transscleral cyclophotocoagulation, laser trabeculoplasty, and potentially antivascular endothelial growth factor therapy. Minimally invasive glaucoma surgery (MIGS) can be considered for eyes with treated, regressed posterior segment malignancies if there is no iris or ciliary body involvement. Importantly, avoidance of MIGS, filtering, or shunting surgery in eyes with active malignancies is emphasized. SUMMARY Intraocular tumors can produce secondary glaucoma. Treatment of the primary tumor can sometimes resolve the glaucoma. Topical, oral, or laser therapies can be considered. Avoidance of MIGS, filtering, or shunting surgery is advised until the malignancy is completely regressed.
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18
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Liu W, Kim JM, Young BK, Nath R, Chen Z, Decker RH, Astrahan MA, Pointdujour-Lim R. Novel Eye Plaque Designs for Brachytherapy of Iris and Ciliary Body Melanoma and the First Clinical Application. Ocul Oncol Pathol 2018; 5:220-227. [PMID: 31049331 DOI: 10.1159/000493269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/17/2018] [Indexed: 12/20/2022] Open
Abstract
Background While traditional eye plaque brachytherapy can be used for the treatment of iris melanoma, it faces challenges of poor patient tolerability due to cornea-plaque touch caused by radius of curvature mismatch and potential dosimetric inaccuracy from incomplete coverage. We present novel plaque designs and the first clinical application of the plaques for iris melanoma. Methods Two dome-shaped plaques (EP2132 and EP1930) were designed to vault above the cornea to treat tumors of the iris and ciliary body. Image-based treatment planning of the first 2 clinical cases using the EP2132 plaque covered the tumor base plus a 2 mm margin and the involved ciliary body with at least 75 Gy to the tumor apex. Results The tumors decreased in size following treatment. The patients tolerated the treatment well. There was no adverse event associated with the traditional iris plaques, such as decreased vision, pain, corneal edema, glaucoma, or cataract. Conclusion The novel dome-shaped plaques for the treatment of iris melanoma provide effective dose distribution, improved surgical maneuverability, and increased tolerability for the patient. This plaque model can be used to treat iris melanoma of various sizes, configurations, and locations, including the ciliary body. The need for a customized plaque platform for each patient is minimized.
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Affiliation(s)
- Wu Liu
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Smilow Cancer Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jenna May Kim
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Benjamin K Young
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ravinder Nath
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Smilow Cancer Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Zhe Chen
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Smilow Cancer Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Roy H Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Smilow Cancer Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Renelle Pointdujour-Lim
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Smilow Cancer Center, Yale University School of Medicine, New Haven, Connecticut, USA
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19
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Gapsis BC, Warren NA, Nutaitis MJ, Bonaparte LA, Cooper SL, Ashenafi M, Grossniklaus HE, Magrath GN. Iris melanoma presenting as childhood glaucoma. Am J Ophthalmol Case Rep 2018; 11:56-60. [PMID: 30023461 PMCID: PMC6047055 DOI: 10.1016/j.ajoc.2018.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/24/2018] [Accepted: 05/24/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose To describe the natural history and management of a rare case of iris melanoma in a pediatric patient. Observations A Caucasian female presented with left pupillary abnormalities at age 7, progressive iris changes at age 9, and markedly elevated intraocular pressure with advanced optic nerve cupping at 11 years of age. She was found to have a pigmented lesion overlying her iris and invading her angle. Trans-corneal fine needle aspirate biopsy demonstrated malignant melanoma of the iris. The patient subsequently underwent Iodine-125 plaque brachytherapy for the tumor. Conclusions and Importance: Early identification and treatment of iris melanoma may be associated with decreased risk of local progression and metastatic disease. Treatment of glaucoma in conjunction with uveal melanoma is complicated by tumor specific considerations, including treatment of the tumor and prevention of metastasis.
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Affiliation(s)
- Briana C. Gapsis
- Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA
| | - Nichelle A. Warren
- Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew J. Nutaitis
- Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA
| | - Leah A. Bonaparte
- Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA
| | - Samuel L. Cooper
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Michael Ashenafi
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Hans E. Grossniklaus
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - George N. Magrath
- Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA
- Corresponding author. Storm Eye Institute, Medical University of South Carolina, 167 Ashley Ave, Charleston, SC, 29425.
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20
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Secondary Glaucoma due to Iridescent Crystalline Particles Masquerading as Refractory Hypertensive Uveitis in an Eye With Irradiated Iris Melanoma. J Glaucoma 2018; 27:385-388. [PMID: 29394206 DOI: 10.1097/ijg.0000000000000891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We report a previously unrecognized mechanism of secondary glaucoma due to iridescent crystalline particles released from an irradiated iris melanoma. It masqueraded as refractory hypertensive uveitis following uncomplicated phacoemulsification. MATERIALS AND METHODS A 58-year-old gentleman had an iris melanoma that underwent successful regression following irradiation with proton beam radiotherapy. Three years later an uncomplicated phacoemulsification with intraocular lens implant was performed and subsequently the patient presented with apparently "refractory hypertensive uveitis." Closer examination identified unique iridescent crystalline particles originating from a disintegrating tumor and dispersing within the anterior chamber and drainage angle. The patient developed a unilateral secondary open-angle glaucoma attributable to these particles. Ultrasound biomicroscopy of the anterior segment confirmed absence of tumor recurrence or intrascleral spread and systemic investigations ruled out distant metastases. RESULTS The intraocular pressure was refractory to maximal medical treatment, but was eventually controlled with trans-scleral diode laser cyclo-photocoagulation. CONCLUSIONS This is the first report of a secondary glaucoma attributable to trabecular blockage with iridescent crystalline particulate material released from a disintegrating, previously irradiated, iris melanoma. Proton beam radiotherapy and possibly phacoemulsification may have played a role in triggering the release of these previously undescribed particles from the atrophied tumor surface. This unique mechanism of secondary glaucoma needs to be kept in mind in such rare cases. Trans-scleral cyclodiode laser may be used as a good initial option in such cases to minimize potential risk of tumor seeding with incisional glaucoma surgery.
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21
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Reply. Cornea 2018; 37:e6-e7. [DOI: 10.1097/ico.0000000000001456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Shields CL, Di Nicola M, Bekerman VP, Kaliki S, Alarcon C, Fulco E, Shields JA. Iris Melanoma Outcomes Based on the American Joint Committee on Cancer Classification (Eighth Edition) in 432 Patients. Ophthalmology 2018; 125:913-923. [PMID: 29342436 DOI: 10.1016/j.ophtha.2017.11.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/04/2017] [Accepted: 11/30/2017] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The American Joint Committee on Cancer (AJCC) classification was updated to the eighth edition in January 2017, providing staging for iris melanoma. This study evaluated outcomes of iris melanoma per the AJCC classification, eighth edition. DESIGN Retrospective case series. PARTICIPANTS Four hundred thirty-two patients with iris melanoma. METHODS Management including tumor resection, plaque radiotherapy, or enucleation. MAIN OUTCOME MEASURES Local tumor recurrence, melanoma-related systemic metastasis, and melanoma-related death. RESULTS Of 432 patients with iris melanoma, AJCC classification was category T1 (n = 324 [75%]), T2 (n = 83 [19%]), T3 (n = 2 [<1%]), and T4 (n = 23 [5%]). There was no difference in age, race, gender, eye, or iris color among T categories. Overall, Kaplan-Meier analysis of outcomes (at 5 and 10 years) revealed visual acuity reduction by 3 lines or more (42% and 54%, respectively), secondary glaucoma (29% and 33%, respectively), local recurrence (8% and 17%, respectively), secondary enucleation (12% and 19%, respectively), lymph node metastasis (1% and 1%, respectively), melanoma-related systemic metastasis (5% and 10%, respectively), and melanoma-related death (3% and 4%, respectively). Compared with T1 category, the hazard ratio (HR) for local recurrence in nonenucleated eyes was 1.31 for T2, not evaluable (NE) for T3 (because of small cohort), and 6.61 for T4; the HR for metastasis was 3.41 for T2, NE for T3 (because of small cohort), and 25.6 for T4; the HR for death was 7.51 for T2, NE for T3 (because of small cohort), and 26.5 for T4; and the odds ratio for enucleation was 1.23 for T2, 3.63 for T3, and 4.72 for T4. Features predictive of melanoma-related metastasis (multivariate analysis) included secondary glaucoma (P < 0.001; HR, 4.51), T2 category (vs. T1; P = 0.01; HR, 4.09), and T4 category (vs. T1; P < 0.001; HR, 30.8). Features predictive of melanoma-related death (multivariate analysis) included older age (P = 0.008; HR, 2.16 per 10-year increase), T2 category (vs. T1; P = 0.005; HR, 8.07), and T4 category (vs. T1; P < 0.001; HR, 20.3). CONCLUSIONS The AJCC eighth edition classification provides prognostic stratification of iris melanoma. By multivariate analysis, the ratio for melanoma-related metastasis was 4 times greater in category T2 and 31 times greater in T4 compared with T1. The ratio for melanoma-related death was 8 times greater in category T2 and 20 times greater in T4 compared with T1. The cohort size for T3 was too small to provide useful information.
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Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Maura Di Nicola
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Vladislav P Bekerman
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Swathi Kaliki
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carolina Alarcon
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Enzo Fulco
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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23
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Limbal Stem Cell Preservation During Proton Beam Irradiation for Diffuse Iris Melanoma. Cornea 2017; 37:e6. [PMID: 29135712 DOI: 10.1097/ico.0000000000001457] [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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24
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Marinkovic M, Horeweg N, Laman MS, Bleeker JC, Ketelaars M, Peters FP, Luyten GPM, Creutzberg CL. Ruthenium-106 brachytherapy for iris and iridociliary melanomas. Br J Ophthalmol 2017; 102:1154-1159. [PMID: 29122824 DOI: 10.1136/bjophthalmol-2017-310688] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 10/23/2017] [Accepted: 10/26/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate ruthenium-106 (Ru106) brachytherapy as eye-conserving treatment of iris melanomas (IMs) and iridociliary melanomas (ICMs). MATERIALS AND METHODS Eighty-eight patients received Ru106 brachytherapy between 2006 and 2016. Primary outcome was local control, and secondary outcomes were metastasis, survival, eye preservation, complications and visual acuity (VA). RESULTS Overall median follow-up was 36 months. Of 88 patients, 58 (65.9%) had IM and 30 (34.1%) had ICM. ICM were on average larger and more advanced than IM. Local failure-free survival at 3years was 98.9% (SE 1.2%). Metastasis-free survival was 98.2% (SE 1.8%) at 3years; no deaths due to melanoma occurred during follow-up. Eye preservation rate was 97.7%. Treatment-related toxicities were mostly mild and observed in 80.7% of the patients. Common toxicities were worsening of pre-existing or new cataract (51.1%), dry eyes (29.5%) and glaucoma (20.5%). VA was not affected by Ru106 brachytherapy, with only 2.3% having VA <0.33 (low vision) at follow-up. CONCLUSIONS Ru106 for IM and ICM yielded excellent local control (98.9%) and eye preservation (97.7%). Toxicities were common, but mostly mild and transient. Moreover, Ru106 did not affect visual acuity.
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Affiliation(s)
- Marina Marinkovic
- Department of Ophthalmology and Melanoma Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Nanda Horeweg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mirjam S Laman
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaco C Bleeker
- Department of Ophthalmology and Melanoma Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Martijn Ketelaars
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Femke P Peters
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gre P M Luyten
- Department of Ophthalmology and Melanoma Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
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25
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Abstract
A 31-month-old white boy was evaluated for multiple iris lesions in his left eye, initially suspected to be juvenile xanthogranuloma and later diagnosed as tapioca nevi. Four years later the tumors enlarged. There was invasion throughout the anterior segment into the angle and related secondary elevation in intraocular pressure. Fine-needle aspiration biopsy disclosed spindle-B melanoma. Treatment with custom-designed iodine-125 plaque radiotherapy resulted in tumor regression and stabilization of intraocular pressure.
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Affiliation(s)
- Maxwell R Harley
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Raksha Rao
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sara E Lally
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Abstract
PURPOSE To report the outcome after limbal stem cell preservation during proton beam irradiation for diffuse iris melanoma. METHODS This is a single-case report of diffuse iris melanoma that was managed with proton beam radiation (53 Gy), wherein preemptively harvested superior and inferior limbal stem cells before radiation were replaced after irradiation. Regeneration of the palisades of Vogt and the limbal stem cells was documented by an optical coherence tomography-based imaging protocol. RESULTS At 24 months after radiation therapy, best-corrected visual acuity was 20/25. The cornea was clear without evidence of limbal stem cell dysfunction. Clinical examination (including gonioscopy and ultrasound biomicroscopy [UBM]) was indicative of local control, and systemic surveillance was negative for metastatic disease. At posttransplant (21 months), there were more palisade structures visible in both anterior and posterior regions of the superior and inferior limbus, and the linear presentation of the inferior palisades appears to have regenerated. CONCLUSIONS Diffuse iris melanoma can be managed successfully with proton beam radiation while preserving corneal limbal stem cells by harvesting them before radiation and then replacing them after irradiation. Regeneration of the palisades of Vogt could be documented by an optical coherence tomography-based imaging protocol.
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Agraval U, Sobti M, Russell HC, Lockington D, Ritchie D, Cauchi P, Kemp EG, Chadha V. Use of Ruthenium-106 Brachytherapy for Iris Melanoma: The Scottish Experience. Br J Ophthalmol 2017; 102:74-78. [PMID: 28600302 DOI: 10.1136/bjophthalmol-2017-310278] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/24/2017] [Accepted: 04/29/2017] [Indexed: 11/04/2022]
Abstract
PURPOSE To analyse long-term outcomes of ruthenium-106 (106Ru) plaque brachytherapy for the treatment of iris melanoma. METHODS We retrospectively reviewed medical records of 19 consecutive patients with pure iris melanoma treated with 106Ru plaque brachytherapy between 1998 and 2016 at the Scottish Ophthalmic Oncology Service, Glasgow. The iris melanoma was treated with a ruthenium plaque placed on the corneal surface to deliver a surface dose of 555 Gy. We analysed vision preservation, local tumour control, radiation-related complications, eye retention rates, symptomatic metastasis and melanoma-related mortality. RESULTS The mean largest basal diameter of the lesions was 3.50±1.42 mm (range 1.6-6.5 mm), and the mean maximum height was 1.47±0.65 mm (range 0.7-2.8 mm). The tumour control and eye retention were 100% at a mean follow-up of 62 months (range 6-195 months). A 62% reduction in tumour height was observed on ultrasonography. Complications included cataract (68%), dry eye (47%), uveitis (37%) and scleral thinning (5%). At the final follow-up visit, the mean loss of Snellen visual acuity was 1.11±2.90 lines and vision of 6/9 or better was maintained in 53% of patients. None of the patients had evidence of symptomatic metastasis (non-imaged) or melanoma-related mortality. CONCLUSIONS 106Ru plaque treatment for iris melanoma was highly effective a high tumour control, no tumour recurrences and a relatively a low complication rate.
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Affiliation(s)
- Umiya Agraval
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - Manvi Sobti
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - Heather C Russell
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - David Lockington
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - Diana Ritchie
- Oncology, Beatson West of Scotland Cancer Center, Glasgow, UK
| | - Paul Cauchi
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - Ewan G Kemp
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - Vikas Chadha
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
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Dogrusöz M, Jager MJ, Damato B. Corrigendum : Uveal Melanoma Treatment and Prognostication. Asia Pac J Ophthalmol (Phila) 2017; 6:305. [PMID: 28561548 DOI: 10.22608/apo.201734] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/24/2017] [Indexed: 02/06/2023] Open
Affiliation(s)
| | | | - Bertil Damato
- Departments of Ophthalmology and Radiation Oncology, University of California, San Francisco, California, United States
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Popovic M, Ahmed IIK, DiGiovanni J, Shields CL. Radiotherapeutic and surgical management of iris melanoma: A review. Surv Ophthalmol 2017; 62:302-311. [DOI: 10.1016/j.survophthal.2016.12.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 12/16/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
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Singh AD. Small incision guarded hydroaspiration of iris lesions. Br J Ophthalmol 2017; 101:1570-1575. [DOI: 10.1136/bjophthalmol-2016-310093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/09/2017] [Accepted: 02/18/2017] [Indexed: 11/03/2022]
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Kaliki S, Shields CL. Uveal melanoma: relatively rare but deadly cancer. Eye (Lond) 2016; 31:241-257. [PMID: 27911450 DOI: 10.1038/eye.2016.275] [Citation(s) in RCA: 358] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 11/01/2016] [Indexed: 01/04/2023] Open
Abstract
Although it is a relatively rare disease, primarily found in the Caucasian population, uveal melanoma is the most common primary intraocular tumor in adults with a mean age-adjusted incidence of 5.1 cases per million per year. Tumors are located either in iris (4%), ciliary body (6%), or choroid (90%). The host susceptibility factors for uveal melanoma include fair skin, light eye color, inability to tan, ocular or oculodermal melanocytosis, cutaneous or iris or choroidal nevus, and BRCA1-associated protein 1 mutation. Currently, the most widely used first-line treatment options for this malignancy are resection, radiation therapy, and enucleation. There are two main types of radiation therapy: plaque brachytherapy (iodine-125, ruthenium-106, or palladium-103, or cobalt-60) and teletherapy (proton beam, helium ion, or stereotactic radiosurgery using cyber knife, gamma knife, or linear accelerator). The alternative to radiation is enucleation. Although these therapies achieve satisfactory local disease control, long-term survival rate for patients with uveal melanoma remains guarded, with risk for liver metastasis. There have been advances in early diagnosis over the past few years, and with the hope survival rates could improve as smaller tumors are treated. As in many other cancer indications, both early detection and early treatment could be critical for a positive long-term survival outcome in uveal melanoma. These observations call attention to an unmet medical need for the early treatment of small melanocytic lesions or small melanomas in the eye to achieve local disease control and vision preservation with the possibility to prevent metastases and improve overall patient survival.
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Affiliation(s)
- S Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
| | - C L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
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Ajamil Rodanés S, García-Álvarez C, Saornil Alvarez MA, López-Lara F, Frutos Baraja JM, Quiñones M. Melanomalytic glaucoma secondary to iris melanoma. ACTA ACUST UNITED AC 2016; 92:379-381. [PMID: 27746064 DOI: 10.1016/j.oftal.2016.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/06/2016] [Accepted: 08/08/2016] [Indexed: 11/16/2022]
Abstract
CLINICAL CASE A 35-year-old male with unilateral ocular hypertension in the right eye (RE). Anterior segment examination of the RE showed a melanotic lesion. Intraocular pressure (IOP) was 40mmHg in RE. Gonioscopy revealed extension into the anterior chamber angle. Excisional biopsy was performed and consistent with iris melanoma and secondary melanomalytic glaucoma. Brachytherapy was performed as adjuvant therapy. DISCUSSION In patients presenting with unilateral glaucoma and increased pigmentation in the trabecular meshwork, it is crucial to perform imaging studies. Resection by iridectomy with adjuvant episcleral brachytherapy is effective in controlling the disease.
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Affiliation(s)
- S Ajamil Rodanés
- Unidad de Tumores Intraoculares, Servicio de Oftalmología y Radioterapia, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - C García-Álvarez
- Unidad de Tumores Intraoculares, Servicio de Oftalmología y Radioterapia, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M A Saornil Alvarez
- Unidad de Tumores Intraoculares, Servicio de Oftalmología y Radioterapia, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - F López-Lara
- Unidad de Tumores Intraoculares, Servicio de Oftalmología y Radioterapia, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - J M Frutos Baraja
- Unidad de Tumores Intraoculares, Servicio de Oftalmología y Radioterapia, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M Quiñones
- Unidad de Tumores Intraoculares, Servicio de Oftalmología y Radioterapia, Hospital Clínico Universitario de Valladolid, Valladolid, España
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Nevoid iris melanoma, case report. ACTA ACUST UNITED AC 2016; 92:347-350. [PMID: 27262610 DOI: 10.1016/j.oftal.2016.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 11/21/2022]
Abstract
CASE REPORT The case is presented of a patient with diagnosis of iris nevus in the left eye in youth with a poor follow-up, who referred a decreased visual acuity in that eye. A hyphaema and a 3×4×3mm nodule with irregular pigmentation was observed. Excision of the tumour and histological analysis confirmed the suspicion of iris melanoma in stage Ia. DISCUSSION Despite the low grade malignancy of iris melanoma and the low frequency of transformation of iris nevus into melanoma, a follow-up is required for its early diagnosis and treatment.
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Fort M, Guet S, Husheng S, Calitchi E, Belkacemi Y. Role of radiation therapy in melanomas: Systematic review and best practice in 2016. Crit Rev Oncol Hematol 2016; 99:362-75. [PMID: 26829895 DOI: 10.1016/j.critrevonc.2016.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 12/02/2015] [Accepted: 01/16/2016] [Indexed: 12/11/2022] Open
Abstract
Radiotherapy has been used for skin cancers since early after the discovery of X-rays. The introduction of sophisticated surgery techniques and information of the general population on potential late radiation-induced toxicity and carcinogenesis have led to limiting indications in the dermatologist community. However, radiotherapy (RT) has undergone considerable developments, essentially including technological advances, to sculpt radiation delivery, with demonstration of the benefit either alone or after adding concomitant cytotoxic agents or targeted therapies. Although side effects due to high doses and/or the use of old RT techniques have been significantly decreased, the risk of atrophic scars, ulcerations or secondary cancers persist. In this systematic review, we aim to discuss indications for RT in melanomas with focus on new advances that may lead to rehabilitating this treatment option according to the tumor radiosensitivity and clinical benefit/risk ratio. Melanomas have been considered as radioresistant tumors for many years.
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Affiliation(s)
- Magali Fort
- Radiation Oncology Department of Henri Mondor University Hospital and University Paris-Est Creteil (UPEC), Créteil, France
| | - Saada Guet
- Radiation Oncology Department of Henri Mondor University Hospital and University Paris-Est Creteil (UPEC), Créteil, France
| | - Shan Husheng
- Radiation Oncology Department of Henri Mondor University Hospital and University Paris-Est Creteil (UPEC), Créteil, France
| | - Elie Calitchi
- Radiation Oncology Department of Henri Mondor University Hospital and University Paris-Est Creteil (UPEC), Créteil, France; Henri Mondor Breast Center and University of Paris-Est Creteil (UPEC), Créteil, France
| | - Yazid Belkacemi
- Radiation Oncology Department of Henri Mondor University Hospital and University Paris-Est Creteil (UPEC), Créteil, France; Henri Mondor Breast Center and University of Paris-Est Creteil (UPEC), Créteil, France.
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Diffuse Anterior Retinoblastoma with Globe Salvage and Visual Preservation in 3 Consecutive Cases. Ophthalmology 2015; 123:378-384. [PMID: 26522706 DOI: 10.1016/j.ophtha.2015.09.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 09/28/2015] [Accepted: 09/29/2015] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Diffuse anterior retinoblastoma is an exquisitely rare variant of retinoblastoma in which the tumor resides in the anterior segment of the eye, without apparent retinal involvement. Previously published cases have been managed with enucleation. We describe globe salvage and visual preservation in 3 consecutive cases using chemotherapy and radiotherapy. DESIGN Retrospective case series. PARTICIPANTS Three children with diffuse anterior retinoblastoma. METHODS Plaque radiotherapy plus intravenous chemotherapy. MAIN OUTCOME MEASURES Globe and vision preservation. RESULTS The mean patient age at presentation elsewhere was 5.7 years (median, 7; range, 3-7 years). There were 2 white female patients and 1 African American male patient. The initial observation by parents/caregiver was reduced vision (n = 1), red eye (n = 1), or cloudy eye (n = 1), and the initial finding by physician was iris tumor (n = 2) or hyphema (n = 1). Referring diagnosis was iris melanoma (n = 1), infectious endotheliitis (n = 1), and possible tumor (nonspecified) (n = 1). At our evaluation, visual acuity was 20/50 to 20/60 (n = 2) and fix no follow (n = 1). In all cases, the opposite eye was normal. Mean intraocular pressure was 20 mm Hg (median, 16; range, 15-30 mmHg). Our examination revealed solid iris tumor (n = 3), ciliary body involvement (n = 2), and anterior chamber seeding (n = 3). In no case was there choroidal or retinal tumor, vitreous seed or subretinal seed, or extrascleral extension. Clear corneal fine-needle aspiration biopsy confirmed the diagnosis as retinoblastoma in each case. Treatment included plaque radiotherapy (n = 3) plus additional systemic chemotherapy (n = 2). At mean follow-up of 35 months (median, 34; range, 20-51 months), there has been no recurrence, extrascleral extension, enucleation, metastasis, or death. In all 3 cases, cataract surgery was necessary at a mean interval of 16 months after complete and stable regression of retinoblastoma. CONCLUSIONS The rare diffuse anterior form of retinoblastoma can be managed with globe-salvaging alternatives and with visual preservation in selected cases.
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Jardel P, Caujolle JP, Gastaud L, Maschi C, Sauerwein W, Thariat J. [Malignant tumours of the eye: Epidemiology, diagnostic methods and radiotherapy]. Cancer Radiother 2015; 19:762-74. [PMID: 26508321 DOI: 10.1016/j.canrad.2015.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/23/2015] [Indexed: 12/12/2022]
Abstract
Malignant tumours of the eye are not common, barely representing 1 % of all cancers. This article aims to summarise, for each of the main eye malignant diseases, aspects of epidemiology, diagnostic methods and treatments, with a focus on radiation therapy techniques. The studied tumours are: eye metastasis, intraocular and ocular adnexal lymphomas, uveal melanomas, malignant tumours of the conjunctive, of the lids, and retinoblastomas. The last chapter outlines ocular complications of radiation therapy and their management.
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Affiliation(s)
- P Jardel
- Service d'oncologie radiothérapie, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France.
| | - J-P Caujolle
- Service d'ophtalmologie, hôpital Saint-Roch, CHU de Nice, 5, rue Pierre-Dévoluy, 06000 Nice, France
| | - L Gastaud
- Service d'oncologie médicale, centre Antoine-Lacassagne, 33, avenue de la Lanterne, 06189 Nice, France
| | - C Maschi
- Service d'ophtalmologie, hôpital Saint-Roch, CHU de Nice, 5, rue Pierre-Dévoluy, 06000 Nice, France
| | - W Sauerwein
- NC Team, Strahlenklinik, hôpital universitaire, 45122 Essen, Allemagne
| | - J Thariat
- Unité CyberKnife et protonthérapie, service d'oncologie radiothérapie, centre Antoine-Lacassagne, 227, avenue de la Lanterne, 06200 Nice, France
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UNTREATED IRIS MELANOMA COMPLICATED BY HYPHEMA AND UNCONTROLLED GLAUCOMA RESPONSIVE TO IODINE-125 BRACHYTHERAPY. Retin Cases Brief Rep 2015; 10:44-7. [PMID: 26383516 DOI: 10.1097/icb.0000000000000171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe a case of iris melanoma for which a patient refused treatment for 15 years, and the complications that resulted. METHODS Single case report. RESULTS A 52-year-old white man was evaluated for a suspicious pigmented lesion of the left iris. He was followed closely with serial examinations and ultrasound biomicroscopy, and he refused therapy when the lesion showed growth 15 years after presentation. The patient subsequently developed recurrent hyphema, intraocular pressure up to 55 mmHg, and glaucomatous optic neuropathy. He eventually underwent iodine-125 brachytherapy resulting in tumor regression and improvement of intraocular pressure. CONCLUSION Untreated iris melanoma can develop complications such as recurrent hyphema and glaucoma with irreversible optic nerve damage. Treatment of slow-growing iris melanoma must be considered to prevent complications.
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Yang M, Wang W, Yan JH, Li XY, Zhou MW, Huang WB, Zhang XL. Eye tumors misdiagnosed as glaucoma. Chin Med J (Engl) 2015; 128:273-6. [PMID: 25591574 PMCID: PMC4837850 DOI: 10.4103/0366-6999.149233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | | | - Jian-Hua Yan
- Department of Strabismus and Amblyopia, State Key Laboratory of Ophthalmology, Sun Yat sen University, Guangzhou, Guangdong 510060, China
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Feng S, Wang L, Xiao Z, Maharjan R, Chuanxing L, Fujun Z, Jinhua H, Peihong W. 125I Seed Implant Brachytherapy for Painful Bone Metastases After Failure of External Beam Radiation Therapy. Medicine (Baltimore) 2015; 94:e1253. [PMID: 26252288 PMCID: PMC4616588 DOI: 10.1097/md.0000000000001253] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study was to evaluate the safety and therapeutic efficacy of computed tomography (CT)-guided I seed implant brachytherapy in patients with painful metastatic bone lesions after failure of external beam radiation therapy (EBRT).From August 2012 to July 2014, 26 patients with painful bone metastases after failure of EBRT were treated with CT-guided I seed implant brachytherapy. Patient pain and analgesic use were measured using the Brief Pain Inventory before treatment, weekly for 4 weeks, and every 4 weeks thereafter for a total of 24 weeks. Opioid analgesic medications and complications were monitored at the same follow-up intervals.Before I seed implantation, the mean score for worst pain in a 24-hour period was 7.3 out of 10. Following treatment, at weeks 1, 4, 8, 12, and 24, worst pain decreased to 5.0 (P < 0.0001), 3.0 (P < 0.0001), 2.8 (P < 0.0001), 2.6 (P < 0.0001), and 2.0 (P = 0.0001), respectively. Opioid usage significantly decreased at weeks 4, 8, and 12. Overall response rates of osseous metastases after I seed implantation at 1, 4, 8, 12, and 24 weeks were 58%, 79%, 81%, 82%, and 80%, respectively. Adverse events were seen in 4 patients, including Grade 1 myelosuppression and Grade 1 late skin toxicity.I seed brachytherapy is a safe and effective treatment for patients with painful bone metastases after failure of EBRT.
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Affiliation(s)
- Shi Feng
- From the State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China (SF, LW, LC, ZF, HJ, RM, WP); and Chinese People's Liberation Army General Hospital (301 Hospital), Beijing, China (ZX)
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Saakyan SV, Amiryan AG, Valskiy VV, Mironova IS. [Plaque radiotherapy for anterior uveal melanomas]. Vestn Oftalmol 2015; 131:5-12. [PMID: 26080576 DOI: 10.17116/oftalma201513125-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To determine the effectiveness of plaque radiation therapy for anterior uveal melanomas and to evaluate the risk and frequency of complications at different time intervals after the treatment. MATERIAL AND METHODS During 2010-2013 a total of 30 patients (10 male, 20 female) aged 11-73 (50 years on the average) with iris or iridociliary melanomas were treated with Ru-106 and Sr-90 ophthalmic plaques. In 8 patients the brachytherapy was preceded by local tumor excision. Morphological diagnosis was verified in 10 patients (8 iridectomies, 2 enucleations), of them 8 cases turned out to be spindle cell melanomas and the other 2--mixed cell melanomas. Follow-up period ranged from 1 to 54 months with the median of 13,5 months. RESULTS Tumor regression was achieved in all cases. Enucleation had to be performed in 2 patients due to cornea and sclera necrosis. In the early post-brachytherapy period (up to 1 month) the most frequent radiation-related complications were keratopathy and uveitis (8 and 6 patients correspondingly). In patients observed for up to 3 months (28 patients) these were keratopathy and cataract (8 and 5 patients correspondingly). In the long-term (over 6 months) cataract predominated (17 patients). At the end of the study all patients were alive. Metastatic disease was diagnosed in one patient 30 months after the treatment. CONCLUSIONS The results of the present clinical study confirm the effectiveness of brachytherapy for iris and iridociliary melanomas, which implies that tumor is well locally controlled and radiation-related complications are moderate and curable. This method of local tumor destruction can be another alternative to enucleation in cases when local tumor excision cannot be performed.
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Affiliation(s)
- S V Saakyan
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - A G Amiryan
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - V V Valskiy
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - I S Mironova
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
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Percutaneous implantation of 125iodine seeds for treatment of portal vein tumor thrombosis in hepatocellular carcinoma. Med Oncol 2015; 32:214. [DOI: 10.1007/s12032-015-0657-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 06/15/2015] [Indexed: 12/18/2022]
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Shields JA, Shields CL. Management of posterior uveal melanoma: past, present, and future: the 2014 Charles L. Schepens lecture. Ophthalmology 2014; 122:414-28. [PMID: 25439609 DOI: 10.1016/j.ophtha.2014.08.046] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 08/26/2014] [Accepted: 08/27/2014] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To review the management of ciliary body and choroidal melanoma (posterior uveal melanoma [PUM]) over the last century with an emphasis on changing concepts. DESIGN Retrospective review. PARTICIPANTS Review of personal experience over 40 years and pertinent literature on management of PUM. METHODS Diagnosis and therapy for PUM. MAIN OUTCOME MEASURES Patient survival. RESULTS In the early 1900s, most patients presented with a large symptomatic melanoma that necessitated enucleation, and the systemic prognosis was poor. In the 1970s, controversy erupted regarding the role of enucleation for PUM. Some authorities advocated prompt enucleation, and others proposed that enucleation promoted metastasis, known as the "Zimmerman hypothesis." Others recommended observation, withholding treatment until tumor growth was documented. During the 1970s, there was a trend toward eye-saving procedures, including laser photocoagulation, surgical removal of tumor, and techniques of radiotherapy. Despite local treatment success, systemic prognosis remained guarded with approximately 40% mortality overall. However, there was convincing evidence that smaller tumors offered a significantly better prognosis. Currently, there is a movement toward earlier identification and treatment of small melanomas using clinical factors predictive of malignant potential, in keeping with similar philosophy regarding other cancers. Further understanding of melanoma cytogenetics and molecular pathways have helped to recognize patients at risk for metastasis. At-risk patients are offered systemic therapeutic trials to prevent metastasis. We anticipate that the future management of PUM will focus on detection of clinical and imaging clues for earliest diagnosis, prompt local tumor treatment, and systemic targeted therapies for microscopic metastasis or prevention of metastasis. Personalized evaluation of patient-specific melanoma molecular pathway signature could allow for therapeutic intervention at a site specific to the pathway abnormality that leads to the development of melanoma. CONCLUSIONS Management of PUM has made major strides over the past century from the days of enucleation for massive, fatal tumor to early detection of smallest tumors with a more favorable prognosis. Current and future targeted specific tumor pathway interruption using systemic agents could improve survival.
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Affiliation(s)
- Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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Shields CL, Shields PW, Manalac J, Jumroendararasame C, Shields JA. Review of cystic and solid tumors of the iris. Oman J Ophthalmol 2014; 6:159-64. [PMID: 24379549 PMCID: PMC3872564 DOI: 10.4103/0974-620x.122269] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Iris tumors are broadly classified into cystic or solid lesions. The cystic lesions arise from iris pigment epithelium (IPE) or iris stroma. IPE cysts classically remain stable without need for intervention. Iris stromal cyst, especially those in newborns, usually requires therapy of aspiration, possibly with alcohol-induced sclerosis, or surgical resection. The solid tumors included melanocytic and nonmelanocytic lesions. The melanocytic iris tumors include freckle, nevus (including melanocytoma), Lisch nodule, and melanoma. Information from a tertiary referral center revealed that transformation of suspicious iris nevus to melanoma occurred in 4% by 10 years and 11% by 20 years. Risk factors for transformation of iris nevus to melanoma can be remembered using the ABCDEF guide as follows: A=age young (<40 years), B=blood (hyphema) in anterior chamber, C=clock hour of mass inferiorly, D=diffuse configuration, E=ectropion, F=feathery margins. The most powerful factors are diffuse growth pattern and hyphema. Tumor seeding into the anterior chamber angle and onto the iris stroma are also important. The nonmelanocytic iris tumors are relatively uncommon and included categories of choristomatous, vascular, fibrous, neural, myogenic, epithelial, xanthomatous, metastatic, lymphoid, leukemic, secondary, and non-neoplastic simulators. Overall, the most common diagnoses in a clinical series include nevus, IPE cyst, and melanoma. In summary, iris tumors comprise a wide spectrum including mostly iris nevus, IPE cyst, and iris melanoma. Risk factors estimating transformation of iris nevus to melanoma can be remembered by the ABCDEF guide.
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Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA., USA
| | - Patrick W Shields
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA., USA
| | - Janet Manalac
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA., USA
| | | | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA., USA
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Abstract
PURPOSE A case of a teenage girl with tapioca melanoma of the iris is presented. This case is unusual, as the patient did not have heterochromia and did not present with elevated intraocular pressure. CASE REPORT A 14-year-old female patient presented with an amelanotic, multinodular, multifocal lesion of the right iris. Pathology confirmed a diagnosis of tapioca melanoma using immunohistologic staining. The patient underwent enucleation of her right eye and has been free of metastatic disease 3 years later. CONCLUSIONS Tapioca melanoma of the iris must be included among the other differential diagnoses when examining patients with amelanotic iris lesions, even when iris heterochromia is not clearly evident.
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Semenova E, Finger PT. Amniotic Membrane Corneal Buffering During Plaque Radiation Therapy for Anterior Uveal Melanoma. Ophthalmic Surg Lasers Imaging Retina 2013; 44:477-82. [DOI: 10.3928/23258160-20130909-10] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 07/16/2013] [Indexed: 11/20/2022]
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McLaughlin JP, Fung AT, Shields JA, Shields CL. Iris melanoma in children: Current approach to management. Oman J Ophthalmol 2013; 6:53-5. [PMID: 23772128 PMCID: PMC3678200 DOI: 10.4103/0974-620x.111920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Iris melanoma usually affects middle aged, Caucasian patients with light colored eyes. Pediatric iris melanoma is rare. A 15-year-old Caucasian male presented with 1-month history of a brown nodule in the inferotemporal aspect of his left eye. Iris nevus was diagnosed, and the patient was observed. Nearly 2 years later the lesion had grown in basal diameter and thickness, and the tumor was excised by partial lamellar scleral flap and sector iridectomy. Histopathology confirmed spindle cell iris melanoma. Two years post-operatively, tumor recurrence with anterior chamber angle involvement and secondary glaucoma developed. He was then treated with custom designed Iodine125 plaque radiotherapy. This case demonstrates the recurrence of iris melanoma despite proper initial surgical management, and outlines current management options for pediatric iris melanoma.
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Affiliation(s)
- John P McLaughlin
- The Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA, USA
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