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Dini F, Susini P, Zuccaro B, Nisi G, Cuomo R, Grimaldi L, Perillo G, Tinunin L, Antonini P, Innocenti A, Cecchi G, Gambale E, Doni L, Mazzini C, Santoro N, De Giorgi V. Head and neck melanoma: the eyelid region has a better prognosis and easier management. A retrospective survey and systematic review. Melanoma Res 2024; 34:429-438. [PMID: 38833343 DOI: 10.1097/cmr.0000000000000984] [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: 06/06/2024]
Abstract
Eyelid melanoma (EM) is a malignant neoplasm accounting for around 1% of eyelid malignancies. Because of its rarity, most of our knowledge of EM is currently based on studies of cutaneous melanomas located elsewhere. Accordingly, this study aimed to specifically evaluate EM characteristics, management strategies, and prognosis. A retrospective study was carried out on patients diagnosed with EM at Careggi University Hospital, Florence between May 2012 and May 2022. In addition, a systematic review of relevant literature was conducted, encompassing studies published from 2013 to 2023. Clinical, histopathological, therapeutical, and prognostic data were analyzed to assess the metastasis rate and the 5-year survival rate of patients with EM. Separate data were extracted for in situ and invasive disease. Our original study included 19 patients diagnosed with EM with a 5-year survival rate of 100% for in situ and 83.3% for invasive EM. The literature review identified five poorly detailed large database reviews and 14 original studies on EM with an overall 5-year survival rate of 79.7%. The present research indicates that EM is a challenging malignancy, but has a relatively better prognosis and easier management than other melanomas of the head and neck region. These are probably related to the anatomical location which leads to early diagnosis. Therefore, EM should be considered as a specific disease requiring dedicated treatment. Based on the personal authors' experience and comprehensive overview of the current knowledge, a dedicated protocol is proposed.
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Affiliation(s)
- Federica Dini
- Department of Neurosciences, Psychology, Drug Research and Child Health Eye Clinic, University of Florence, Florence
| | - Pietro Susini
- Plastic Surgery Unit, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena
| | | | - Giuseppe Nisi
- Plastic Surgery Unit, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena
| | - Roberto Cuomo
- Plastic Surgery Unit, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena
| | - Luca Grimaldi
- Plastic Surgery Unit, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena
| | | | - Luca Tinunin
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence
| | - Pietro Antonini
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona, Verona
| | | | | | | | - Laura Doni
- Clinical Oncology Unit, Careggi University Hospital
| | - Cinzia Mazzini
- Unit of Ocular Oncology, Department of Neuromuscular and Sense Organs
| | - Nicola Santoro
- Unit of Ocular Oncology, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy
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Wladis EJ, Rothschild MI, Bohnak CE, Adam AP. New therapies for unresectable or metastatic cutaneous eyelid and orbital melanoma. Orbit 2024:1-7. [PMID: 38796755 DOI: 10.1080/01676830.2024.2351514] [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: 04/06/2024] [Accepted: 04/30/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE Newer treatment options offer the promise of improved outcomes for metastatic and unresectable melanoma. This investigation was performed to review these modalities for cutaneous eyelid and orbital disease. METHODS A search for articles that were related to this subject was performed in the PubMed database, and the bibliographies of these manuscripts were reviewed to ensure capture of the appropriate literature. Data was abstracted and analyzed. RESULTS Historically, patients who suffer from melanoma of the ocular adnexa have fared poorly. Approaches that employ BRAF and mitogen-associated protein kinase inhibitors, immunotherapy, and novel cellular therapies improve outcomes and survival rates, although the side effect profiles of these agents are problematic. Most of the existing strategies have not explored ocular adnexal disease specifically, and treatment plans are generally adapted from the general cutaneous oncology literature. CONCLUSIONS Thanks to advances in our comprehension of the cellular biology of the disease, the management of unresectable and metastatic melanoma has evolved considerably over the past several years. Newer modalities will likely continue to improve survival and reduce adverse events.
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Affiliation(s)
- Edward J Wladis
- Department of Ophthalmology, Lions Eye Institute, Albany Medical College, Albany, New York, USA
- Department of Otolaryngology, Albany Medical College, Albany, New York, USA
| | - Michael I Rothschild
- Department of Ophthalmology, Lions Eye Institute, Albany Medical College, Albany, New York, USA
| | - Carisa E Bohnak
- Department of Ophthalmology, Lions Eye Institute, Albany Medical College, Albany, New York, USA
| | - Alejandro P Adam
- Department of Ophthalmology, Lions Eye Institute, Albany Medical College, Albany, New York, USA
- Molecular and Cellular Physiology, Albany Medical College, Albany, New York, USA
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3
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Ju S, Rokohl AC, Guo Y, Yao K, Fan W, Heindl LM. Personalized treatment concepts in extraocular cancer. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2024; 4:69-77. [PMID: 38590555 PMCID: PMC10999489 DOI: 10.1016/j.aopr.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/10/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024]
Abstract
Background The periocular skin is neoplasms-prone to various benign and malignant. Periocular malignancies are more aggressive and challenging to cure and repair than those in other skin areas. In recent decades, immunotherapy has significantly advanced oncology, allowing the autoimmune system to target and destroy malignant cells. Skin malignancies, especially periocular tumors, are particularly sensitive to immunotherapy. This technique has dramatically impacted the successful treatment of challenging tumors. Main text Extraocular cancers, including eyelid (basal cell carcinoma, squamous cell carcinoma, melanoma, merkel cell carcinoma), conjunctival tumors (conjunctival melanoma, ocular surface squamous neoplasia) and other rare tumors, are unique and challenging clinical situations. Several genetic alterations associated with the pathogenesis of these diseases have been identified, and molecular mechanism are essential for the development of the immunotherapy agents, such as Hedgehog pathway inhibitors (vismodegib and sonidegib) for basal cell carcinoma, BRAF/MEK inhibitors (vemurafenib, dabrafenib, and encorafenib) for melanoma, and immune checkpoint inhibitors (Avelumab, pembrolizumab) for Merkel cell carcinoma. Conclusions The optimal treatment for periocular skin cancer depends on the type and size of the tumor and whether it involves orbital and adnexal structures. Adjuvant and neoadjuvant therapy with chemotherapy-targeted therapies and immune checkpoint inhibitors should be considered based on tumor type, tumor molecular profile, expected response rate, and candidacy for systemic treatment.
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Affiliation(s)
- Sitong Ju
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße, Cologne, Germany
| | - Alexander C. Rokohl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße, Cologne, Germany
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
| | - Yongwei Guo
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Ke Yao
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Wanlin Fan
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße, Cologne, Germany
| | - Ludwig M. Heindl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße, Cologne, Germany
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
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4
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Schoelles KJ, Auw-Haedrich C. Updates on eyelid cancers. Asia Pac J Ophthalmol (Phila) 2024; 13:100057. [PMID: 38615904 DOI: 10.1016/j.apjo.2024.100057] [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: 02/03/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/16/2024] Open
Abstract
In this review, we aim to provide an overview of the five most common malignant eyelid tumors with current treatment recommendations based on international guidelines. Particular attention is paid to the clinicopathological correlation and the update with regard to adequate treatment. Newer systemic therapies enrich the existing treatment options, of which complete tumor excision remains the most important therapeutic measure.
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5
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Gniesmer S, Sonntag SR, Schiemenz C, Ranjbar M, Heindl LM, Varde MA, Emmert S, Grisanti S, Kakkassery V. Diagnosis and treatment of malignant eyelid tumors. DIE OPHTHALMOLOGIE 2024; 121:33-39. [PMID: 37851118 DOI: 10.1007/s00347-023-01945-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Malignant tumors of the eyelid are much less frequent than benign eyelid alterations. These are frequently incidental findings without symptoms which are often overlooked or misinterpreted by patients. OBJECTIVE This article gives an overview of clinical aspects, diagnostics and treatment of the five most common malignant eyelid tumors and exemplarily explains the essential principles of evidence-based treatment of malignant eyelid tumors. METHODS This narrative review was prepared based on a selective literature search. The depiction of the treatment of eyelid tumors is supported by illustrations of clinical cases. RESULTS The medical history and inspection provide initial indications of malignancy. Every eyelid change suspected of being malignant should be examined histologically to confirm a diagnosis. By far the most common malignant eyelid tumor in Europe is basal cell carcinoma, which metastasizes only in exceptional cases. Squamous cell carcinomas, sebaceous adenocarcinomas, melanomas and Merkel cell carcinomas occur much less frequently. In these cases, potential metastasis in particular must be considered when making the diagnosis and staging has to be initiated. Surgical excision into healthy tissue with tumor-free margins is the gold standard for malignant eyelid tumors. Non-surgical adjuvant or neoadjuvant forms of evidence-based treatment can be initiated based on the individual case to minimize the risk of recurrence and metastasis. CONCLUSION It is essential to recognize eyelid changes at an early stage, to classify them correctly and to initiate the appropriate treatment. The interaction between the general condition and the personal needs of a patient as well as state of the art medicine are the keys to a good personalized treatment.
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Affiliation(s)
- S Gniesmer
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - S R Sonntag
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - C Schiemenz
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - M Ranjbar
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - L M Heindl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universitätsklinikum Köln, Universität zu Köln, Köln, Germany
- Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Germany
| | - M A Varde
- Augenklinik, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Augenklinik Universitätsspital Zürich, Zürich, Switzerland
| | - S Emmert
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin Rostock, Rostock, Germany
| | - S Grisanti
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - V Kakkassery
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
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Masoomian B, Dalvin LA, Riazi-Esfahani H, Ghassemi F, Azizkhani M, Mirghorbani M, Khorrami-Nejad M, Sajjadi Z, Kaliki S, Sagoo MS, Al Harby L, Al-Jamal RT, Kivelä TT, Giblin M, Lim LAS, Shields CL. Pediatric ocular melanoma: a collaborative multicenter study and meta-analysis. J AAPOS 2023; 27:316-324. [PMID: 37949393 DOI: 10.1016/j.jaapos.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/30/2023] [Accepted: 08/24/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To investigate clinical manifestations and prognoses in pediatric patients (≤12 years old) with ocular melanoma. METHODS This was a retrospective, multicenter cohort study with individual participant data (IPD) meta-analysis pooling available published cases, and unpublished cases from an international collaboration of seven ocular oncology centers. RESULTS There were 133 eyes of 133 pediatric patients with choroidal or ciliary body (n = 66 [50%]), iris (n = 33 [25%]), conjunctival (n = 26 [19%]), and eyelid (n = 8 [6%]) melanoma. Overall, the mean patient age at presentation was 7 years (median, 8; range, 1-12 years), with 63 males (49%). The mean age by tumor site was 6.50 ± 3.90, 7.44 ± 3.57, 9.12 ± 2.61, and 5.63 ± 2.38 years, for choroid/ciliary body, iris, conjunctiva, and eyelid melanoma, respectively (P = 0.001). Association with ocular melanocytosis was seen in 15%, 11%, 4%, and 0%, respectively (P = 0.01). Frequency of ocular melanoma family history did not vary by tumor site (7%, 17%, 9% and 12%, resp. [P = 0.26]). After mean follow-up of 74, 85, 50, and 105 months (P = 0.65), metastasis was seen in 12%, 9%, 19%, and 13% of choroid/ciliary body, iris, conjunctiva, and eyelid melanoma, respectively. Death was reported in 5%, 3%, 8%, and 0%, respectively, with survival analysis indicating higher mortality in choroidal/ciliary body and conjunctival melanoma patients. CONCLUSIONS Ocular melanoma in the pediatric population is rare, with unique clinical features and outcomes. Iris melanoma accounts for about one-third of pediatric uveal melanoma cases.
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Affiliation(s)
- Babak Masoomian
- Ocular Oncology Service, Farabi Eye Hospital Research Center, Tehran university of medical sciences, Tehran, Iran; Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Hamid Riazi-Esfahani
- Ocular Oncology Service, Farabi Eye Hospital Research Center, Tehran university of medical sciences, Tehran, Iran
| | - Fariba Ghassemi
- Ocular Oncology Service, Farabi Eye Hospital Research Center, Tehran university of medical sciences, Tehran, Iran
| | - Momeneh Azizkhani
- Ocular Oncology Service, Farabi Eye Hospital Research Center, Tehran university of medical sciences, Tehran, Iran
| | - Masoud Mirghorbani
- Ocular Oncology Service, Farabi Eye Hospital Research Center, Tehran university of medical sciences, Tehran, Iran
| | - Masoud Khorrami-Nejad
- Ocular Oncology Service, Farabi Eye Hospital Research Center, Tehran university of medical sciences, Tehran, Iran
| | - Zaynab Sajjadi
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Mandeep S Sagoo
- Ocular Oncology Service, St Bartholomew's and Moorfields Eye Hospital, London, United Kingdom and NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Lamis Al Harby
- Ocular Oncology Service, St Bartholomew's and Moorfields Eye Hospital, London, United Kingdom and NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Rana'a T Al-Jamal
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tero T Kivelä
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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7
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[Diagnosis and treatment of malignant eyelid tumors]. DIE OPHTHALMOLOGIE 2023; 120:262-270. [PMID: 36757434 DOI: 10.1007/s00347-023-01820-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Malignant tumors of the eyelid are much less frequent than benign eyelid alterations. These are frequently incidental findings without symptoms which are often overlooked or misinterpreted by patients. OBJECTIVE This article gives an overview of clinical aspects, diagnostics and treatment of the five most common malignant eyelid tumors and exemplarily explains the essential principles of evidence-based treatment of malignant eyelid tumors. METHODS This narrative review was prepared based on a selective literature search. The depiction of the treatment of eyelid tumors is supported by illustrations of clinical cases. RESULTS The medical history and inspection provide initial indications of malignancy. Every eyelid change suspected of being malignant should be examined histologically to confirm a diagnosis. By far the most common malignant eyelid tumor in Europe is basal cell carcinoma, which metastasizes only in exceptional cases. Squamous cell carcinomas, sebaceous adenocarcinomas, melanomas and Merkel cell carcinomas occur much less frequently. In these cases, potential metastasis in particular must be considered when making the diagnosis and staging has to be initiated. Surgical excision into healthy tissue with tumor-free margins is the gold standard for malignant eyelid tumors. Non-surgical adjuvant or neoadjuvant forms of evidence-based treatment can be initiated based on the individual case to minimize the risk of recurrence and metastasis. CONCLUSION It is essential to recognize eyelid changes at an early stage, to classify them correctly and to initiate the appropriate treatment. The interaction between the general condition and the personal needs of a patient as well as state of the art medicine are the keys to a good personalized treatment.
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8
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Wang L, Jiang Z, Shao A, Liu Z, Gu R, Ge R, Jia G, Wang Y, Ye J. Self-supervised learning mechanism for identification of eyelid malignant melanoma in pathologic slides with limited annotation. Front Med (Lausanne) 2022; 9:976467. [PMID: 36237543 PMCID: PMC9550873 DOI: 10.3389/fmed.2022.976467] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The lack of finely annotated pathologic data has limited the application of deep learning systems (DLS) to the automated interpretation of pathologic slides. Therefore, this study develops a robust self-supervised learning (SSL) pathology diagnostic system to automatically detect malignant melanoma (MM) in the eyelid with limited annotation. Design Development of a self-supervised diagnosis pipeline based on a public dataset, then refined and tested on a private, real-world clinical dataset. Subjects A. Patchcamelyon (PCam)-a publicly accessible dataset for the classification task of patch-level histopathologic images. B. The Second Affiliated Hospital, Zhejiang University School of Medicine (ZJU-2) dataset – 524,307 patches (small sections cut from pathologic slide images) from 192 H&E-stained whole-slide-images (WSIs); only 72 WSIs were labeled by pathologists. Methods Patchcamelyon was used to select a convolutional neural network (CNN) as the backbone for our SSL-based model. This model was further developed in the ZJU-2 dataset for patch-level classification with both labeled and unlabeled images to test its diagnosis ability. Then the algorithm retrieved information based on patch-level prediction to generate WSI-level classification results using random forest. A heatmap was computed for visualizing the decision-making process. Main outcome measure(s) The area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity were used to evaluate the performance of the algorithm in identifying MM. Results ResNet50 was selected as the backbone of the SSL-based model using the PCam dataset. This algorithm then achieved an AUC of 0.981 with an accuracy, sensitivity, and specificity of 90.9, 85.2, and 96.3% for the patch-level classification of the ZJU-2 dataset. For WSI-level diagnosis, the AUC, accuracy, sensitivity, and specificity were 0.974, 93.8%, 75.0%, and 100%, separately. For every WSI, a heatmap was generated based on the malignancy probability. Conclusion Our diagnostic system, which is based on SSL and trained with a dataset of limited annotation, can automatically identify MM in pathologic slides and highlight MM areas in WSIs by a probabilistic heatmap. In addition, this labor-saving and cost-efficient model has the potential to be refined to help diagnose other ophthalmic and non-ophthalmic malignancies.
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Affiliation(s)
- Linyan Wang
- Department of Ophthalmology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zijing Jiang
- School of Computer Science and Technology, Hangzhou Dianzi University, Hangzhou, China
| | - An Shao
- Department of Ophthalmology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhengyun Liu
- Department of Pathology, Lishui Municipal Central Hospital, Lishui, China
| | - Renshu Gu
- School of Computer Science and Technology, Hangzhou Dianzi University, Hangzhou, China
| | - Ruiquan Ge
- School of Computer Science and Technology, Hangzhou Dianzi University, Hangzhou, China
| | - Gangyong Jia
- School of Computer Science and Technology, Hangzhou Dianzi University, Hangzhou, China
| | - Yaqi Wang
- College of Media Engineering, The Communication University of Zhejiang, Hangzhou, China
- Yaqi Wang,
| | - Juan Ye
- Department of Ophthalmology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Juan Ye,
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Go CC, Kim DH, Go BC, McGeehan B, Briceño CA. Clinicopathologic Characteristics and Prognostic Factors Impacting Survival in Melanoma of the Eyelid. Am J Ophthalmol 2022; 234:71-80. [PMID: 34343490 DOI: 10.1016/j.ajo.2021.07.031] [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: 02/01/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To examine prognostic factors for survival in patients with melanoma of the eyelid. DESIGN Retrospective cohort study. METHODS This population-based study reviewed patients with primary melanoma of the eyelid diagnosed in the Surveillance, Epidemiology and End Results database between 1975 and 2016. The primary outcomes included survival rates estimated by Kaplan-Meier analysis and mortality hazard ratios (HRs) for overall survival and disease-specific survival (DSS). RESULTS The cohort consisted of 2257 patients with cutaneous melanoma of the eyelid, representing 1380 cases of melanoma in situ and 877 cases of invasive melanoma. For melanoma in situ and invasive melanoma respectively, at 5 years, the overall survival rates were 88.6% and 77.1%, while DSS rates were 99.4% and 91.0%. Cox regression analysis for eyelid melanoma indicated that for invasive melanoma, age at diagnosis ≥75 years (HR 2.17 [95% confidence interval {CI} 1.02-4.60]; P = .04), T4 staging (HR 8.45 [95% CI 2.96-25.31]; P < .001), lymph node involvement (HR 3.61 [95% CI 1.12-11.60]; P = .03), and nodular melanoma (HR 3.31 [95% CI 1.50-7.32]; P = .003) histologic subtype were associated with decreased rates of survival. Sex and tumor ulceration did not impact survival. CONCLUSIONS This study is the largest analysis to date that focuses on DSS for cutaneous melanoma of the eyelid. The most significant predictors for invasive melanoma survival are age ≥75 years at diagnosis, T4 staging, lymph node involvement, and the nodular melanoma histologic subtype. Patients with these attributes are at higher risk and should be counseled regarding prognosis.
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10
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Huang YY, Hou TY, Yu WK, Tsai CC, Kao SC, Hsu WM, Liu JL(C. The Clinical Feature and Treatment Outcome of Ocular Melanoma: A 34-Year Experience in a Tertiary Referral Center. Cancers (Basel) 2021; 13:cancers13235926. [PMID: 34885033 PMCID: PMC8657155 DOI: 10.3390/cancers13235926] [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: 10/23/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
Malignant melanoma can arise from melanocytes in various structures of the eye, orbit, and ocular adnexa. We reviewed the clinical features and long-term results of all subjects with histologically proved melanoma originating from any of the ocular and periocular structures in a tertiary referral center. Overall, 88 patients including 47 men were recruited. The tumor was primarily located in the uvea, followed by the conjunctiva, orbit, eyelid, and lacrimal sac. Patients with uveal melanoma were diagnosed at a relatively younger age (47.0 years), while those with orbital and eyelid melanomas were older at presentation (79.5 years and 78.5 years, respectively). The overall local recurrence rate was 9% at a median follow-up of 41.0 months, among which orbital and eyelid melanomas recurred most commonly. The overall mortality rate was 41% in a median duration of 27.2 months (IQR, 13-58 months) from diagnosis, with the highest for lacrimal sac melanoma, followed by melanoma of the orbit, uveal, conjunctiva, and eyelid. Despite prompt local control, the risk for metastasis and mortality was high. Therefore, efficient modalities for early diagnosis and treatment of ocular melanoma are necessary.
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Affiliation(s)
- Yu-Yun Huang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-Y.H.); (T.-Y.H.); (W.-K.Y.); (S.-C.K.); (W.-M.H.); (J.-L.L.)
- School of Medicine, National Yang Ming University, Taipei 11221, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Tzu-Yu Hou
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-Y.H.); (T.-Y.H.); (W.-K.Y.); (S.-C.K.); (W.-M.H.); (J.-L.L.)
- School of Medicine, National Yang Ming University, Taipei 11221, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
| | - Wei-Kuang Yu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-Y.H.); (T.-Y.H.); (W.-K.Y.); (S.-C.K.); (W.-M.H.); (J.-L.L.)
- School of Medicine, National Yang Ming University, Taipei 11221, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Chieh-Chih Tsai
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-Y.H.); (T.-Y.H.); (W.-K.Y.); (S.-C.K.); (W.-M.H.); (J.-L.L.)
- School of Medicine, National Yang Ming University, Taipei 11221, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
- Correspondence: ; Tel.: +886-2-28-757-325
| | - Shu-Ching Kao
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-Y.H.); (T.-Y.H.); (W.-K.Y.); (S.-C.K.); (W.-M.H.); (J.-L.L.)
- School of Medicine, National Yang Ming University, Taipei 11221, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Wen-Ming Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-Y.H.); (T.-Y.H.); (W.-K.Y.); (S.-C.K.); (W.-M.H.); (J.-L.L.)
- School of Medicine, National Yang Ming University, Taipei 11221, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
- Department of Ophthalmology, Taipei Medical University-Shuang-Ho Hospital, Ministry of Health and Welfare, New Taipei City 23561, Taiwan
| | - Jui-Ling (Catherine) Liu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-Y.H.); (T.-Y.H.); (W.-K.Y.); (S.-C.K.); (W.-M.H.); (J.-L.L.)
- School of Medicine, National Yang Ming University, Taipei 11221, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
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11
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Li E, Chambers CB. Diseases of the Eyelids and Orbit. Med Clin North Am 2021; 105:551-562. [PMID: 33926646 DOI: 10.1016/j.mcna.2021.02.007] [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] [Indexed: 11/30/2022]
Abstract
The eyelids and orbit encompass intricate bony and soft tissue structures that work harmoniously in concert to protect, support, and nourish the eye in order to facilitate and maintain its function. Insult to periorbital and orbital anatomy can compromise orbital and ocular homeostasis. This article provides a foundational overview of eyelid and orbital anatomy, as well as common and key disorders that may confront internists and medical subspecialists.
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Affiliation(s)
- Emily Li
- Department of Ophthalmology, University of Washington School of Medicine, Box 359608, 325 9th Avenue, Seattle, WA 98104, USA.
| | - Christopher B Chambers
- Department of Ophthalmology, University of Washington School of Medicine, Box 359608, 325 9th Avenue, Seattle, WA 98104, USA
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Epidemiological Profile and Clinical Stage at Presentation of Eyelid Malignancies in a Multi-Ethnic Country. J Craniofac Surg 2021; 32:e642-e645. [PMID: 33852518 DOI: 10.1097/scs.0000000000007649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Eyelid malignancies are frequently seen in clinical practice. There is a lack of studies that have assessed the features of these lesions in mixed population countries. The epidemiologic profile, clinical stage at presentation, management, and outcomes of patients with eyelid malignancies were assessed, in order to better understand the features of these lesions in a multi-ethnic country. The medical records of patients who underwent eyelid tumor excision in a tertiary service in Brazil, from 2014 to 2019 were retrospectively reviewed. It was recorded for each patient: age, gender, time of onset, location, diagnosis, management, and follow-up. The medical records of 298 patients who presented with eyelid tumors were evaluated and 67 (22.4%) were malignant. The mean age of patients with malignancies was 52.93 years and 50% were male. Basal cell carcinoma was the most prevalent (61.2%), followed by squamous cell carcinoma (SCC) (29.9%) and sebaceous gland carcinoma (3%). The average time it took from appearance to surgical treatment was 3 years; the lower eyelid was the most affected for both basal cell carcinoma and SCC; 70% of SCCs were locally invasive at presentation and metastasis occurred in 15%. Basal cell carcinoma was the most common eyelid malignancy observed, however, its frequency was lower when compared to other western countries. The advanced stage at presentation may reflect the lack of education of the population to seek early care, and the lack of specialized tertiary centers in remote areas, resulting in delayed diagnosis.
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Total saponins from Rubus parvifolius L. inhibits cell proliferation, migration and invasion of malignant melanoma in vitro and in vivo. Biosci Rep 2021; 41:226784. [PMID: 33111956 PMCID: PMC7823183 DOI: 10.1042/bsr20201178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 01/16/2023] Open
Abstract
Background: Total saponins from Rubus parvifolius L. (TSRP) are the main bioactive fractions responsible for the anti-tumor activities. The work was aimed to evaluate the anti-tumor effect of TSRP in malignant melanoma (MM) in vitro and in vivo. Methods and results: Anti-melanoma cell proliferation, invasion and migration effect of TSRP were detected in human MM A375 cells under the indicated time and dosages. In vivo anti-tumor effect of TSRP was measured in A375 xenograft immunodeficient nude mice. Sixty A375 xenografts were randomly divided into five groups: Vehicle, cyclophosphamide (CTX, 20 mg/kg), TSRP (25 mg/kg), TSRP (50 mg/kg) and TSRP (100 mg/kg) groups for 14 days’ treatment. In addition, the melanoma metastasis in lung in vivo of TSRP was detected in A375 tail vein injection mice, and the histopathalogical analysis of the lung metastasis was detected by Hematoxylin–Eosin (H&E) staining. TSRP significantly inhibited the cell proliferation, invasion and migration of A375 in vitro at the indicated time and dosages. TSRP treatment effectively blocked the tumor growth in immunodeficient nude mice. In addition, TSRP also significantly inhibited the lung metastasis of melanoma. Conclusion: The present study indicated that the TSRP has a remarkable anti-MM effect, which mainly through the inhibition of the cell invasion, migration and tumor metastasis.
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14
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Epidemiology and Survival Outcomes for Eyelid Primary Malignant Melanoma: An Analysis of 1397 Cases in the SEER Database. J Ophthalmol 2020; 2020:4858636. [PMID: 33520295 PMCID: PMC7803156 DOI: 10.1155/2020/4858636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/03/2020] [Accepted: 11/23/2020] [Indexed: 02/03/2023] Open
Abstract
Purpose There has not been a recent population-based study regarding the epidemiological trend and survival of eyelid primary malignant melanoma (PMM). Our study aims to evaluate the updated incidence trends and discuss the factors affecting the survival outcomes of eyelid PMM. Methods A total of 1397 eyelid PMM cases diagnosed between 1975 and 2016 were retrospectively identified from the Surveillance, Epidemiology, and End Results (SEER) database. Age-adjusted incidence rates and annual percent changes (APC) were calculated. Kaplan-Meier and Cox proportional hazards regression models were used to calculate survival outcomes and identify potential prognostic factors. Results The overall age-adjusted incidence of eyelid PMM rose from 0.039 (95% confidence interval [CI], 0.012–0.088) in 1975 to 0.103 (95% CI, 0.070–0.143) per 100 000 population in 2016, with significant APC of 1.313% (p < 0.001). Male subjects showed a higher average age-adjusted incidence rate than female subjects (p < 0.001). Survival analyses showed that 5-year accumulative overall survival (OS) and disease-specific survival (DSS) for patients with eyelid PMM were 70.5% and 90.6%. Additionally, 10-year OS and DSS were 51.8% and 86.1%, respectively. Analyses of Kaplan-Meier survival curves with the log-rank test revealed that older age, White race, nodular melanoma, higher American Joint Committee on Cancer (AJCC) stage (II to IV), advanced stage, distant metastasis, and no-surgery treatment were associated with lower OS and DSS rates. Age, histology, AJCC stage, and stage at diagnosis were found to be independent predictors of OS and DSS in multivariate models. Conclusion The incidence of eyelid PMM increased with significant APC and male predominance. Age, histology, AJCC stage, and stage at diagnosis might be independent predictors of prognosis, emphasizing the importance of improved diagnosis of eyelid PMM.
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15
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Brunetti P, Margo CE, French DD. Incidence of Cutaneous Melanoma of Eyelid Analysis of the Surveillance, Epidemiology, and End Results Database. Ocul Oncol Pathol 2020; 7:66-69. [PMID: 33796520 DOI: 10.1159/000511215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/24/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose The aim of this work was to report the annual incidence, incidence trend, histological types, and cause-specific survival of cutaneous melanoma of the eyelid from 1975 through to 2017. Methods Cases were identified in the Surveillance, Epidemiology, and End Results (SEER) database using the ICD-0-3 standard codes for diagnosis and anatomic location. Cutaneous melanomas of the face and scalp/neck were studied as comparison groups. Incidence rates were calculated using the SEER*Stat statistical analysis software with 95% confidence intervals. Melanoma-specific survival was estimated using the Kaplan-Meier product-limited method. Results There was an increase in annual incidence of eyelid melanoma over the 43-year study period, ranging from a low of 0.2 × 106 population in 1978 (95% CI 0.04-0.6) to a high of 1.0 × 106 population in 2016 (95% CI 2.3-3.5). The average annual percent change was 1.2% (95% CI 0.5-1.8). Cause-specific survival of melanoma of the eyelid and facial skin were almost identical (approx. 91.7%) at 60 months but significantly worse for melanoma of the scalp/neck (p < 0.05%). Conclusions Cutaneous melanoma of the eyelid is uncommon compared to melanoma of facial skin and the scalp/neck. This can be explained in part by the comparatively small surface area at risk. Like melanomas elsewhere, the annual incidence of eyelid melanoma has risen over the last 4 decades, but less than of facial skin and the scalp/neck. Over the span of this study, cause-specific survival from eyelid melanoma was comparable to that of facial skin and better than that of the scalp/neck.
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Affiliation(s)
- Philip Brunetti
- Departments of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Curtis E Margo
- Departments of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.,Department of Pathology and Cell Biology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Dustin D French
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Center for Health Service and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Veterans Affairs Health Services Research and Development Service, Chicago, Illinois, USA
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16
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Roelofs KA, Mitsopoulos G, Cohen VML. Conjunctival Melanoma with Ipsilateral, Non-Contiguous Eyelid Involvement: A Case Report and Comprehensive Review of the Literature. Ocul Oncol Pathol 2020; 6:333-338. [PMID: 33123526 DOI: 10.1159/000506950] [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: 12/14/2019] [Accepted: 03/01/2020] [Indexed: 11/19/2022] Open
Abstract
While the majority of cases of conjunctival melanoma (CM) involve the bulbar conjunctiva, concurrent pigmentation of the ipsilateral eyelid can be seen in up to 15% of cases. Although extension of conjunctival melanoma into the eyelid (AJCC cT3b) occurs in 1% of cases, non-contiguous lesions are very rare with only 5 clearly documented reports in the English literature. Several pathophysiological mechanisms have been proposed, including separate primary melanomas, patchy involvement from primary acquired melanosis (which may be sine pigmento) and exfoliation of malignant tumour cells into the tear film. Herein we present a case of eyelid melanoma arising in a patient previously treated for CM at a non-contiguous site and provide a comprehensive review of the relevant literature.
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Affiliation(s)
- Kelsey A Roelofs
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom
| | | | - Victoria M L Cohen
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom.,NIHR Biomedical Research Centre, UCL Institute of Ophthalmology, London, United Kingdom
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17
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Oliver JD, Boczar D, Sisti A, Huayllani MT, Restrepo DJ, Spaulding AC, Gabriel E, Bagaria S, Rinker BD, Forte AJ. Eyelid Melanoma in the United States: A National Cancer Database Analysis. J Craniofac Surg 2019; 30:2412-2415. [PMID: 31233000 DOI: 10.1097/scs.0000000000005673] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Eyelid melanoma (EM) is a rare condition that accounts for <1% of all cutaneous melanomas. In this analysis, patients diagnosed with EM in the United States were compared to those with other melanomas in the head and neck. METHODS The National Cancer Database was used to select patients with head and neck melanoma from 2004 to 2015. RESULTS A total of 137,233 patients met the criteria of the study. Among them, 2694 were diagnosed with EM (2%) and 134,539 in other head and neck locations (98%). Regarding the patients with EM, the mean age was 68.56 years (standard deviation 14.04). A greater number of them were treated in Academic/Research Programs (53.6%), insured by Medicare (55.7%), tumor in situ (52.2%), stage 0 (49%), and without ulceration (75.9%). The mean time to treatment commencement was 18.96 days for EM compared to 14.4 days for other melanoma in the head and neck regions (P < 0.001). There was a greater proportion of EM in female patients (odds ratio [OR] 2.371 [2.191-2.566], P < 0.001), compared to male; age greater than 80 years (OR 1.622 [1.360-1.934], P < 0.001) compared to 0 to 49 years. Moreover, EM was an independent predictor for treatment in Academic/Research Programs (OR 1.258 [1.160-1.365], P < 0.001) and diagnosis at autopsy (OR 1.414 [1.083-1.847], P = 0.011) compared to other melanoma in the head and neck region. CONCLUSION These novel findings have the potential to guide clinical decision making in head and neck melanoma management.
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Affiliation(s)
| | | | | | | | | | - Aaron C Spaulding
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
| | | | | | | | - Antonio J Forte
- Division of Plastic Surgery
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
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