Trends in the incidence of ocular melanoma in the United States, 1974–1998

Metastatic ocular melanoma to the liver exhibits infiltrative and nodular growth patterns

We examined liver specimens from 15 patients with uveal melanoma (UM) who had died of their disseminated disease. We found 2 distinct growth patterns of UM metastasis: infiltrative (n = 12) and nodular (n = 3). In the infiltrative pattern, individual UM cells with a CD133+ cancer stem cell-like phenotype were present and formed aggregates of stage I <50-μm-diameter micrometastases in the sinusoidal spaces. These micrometastases appeared to expand, destroy adjacent hepatocytes, and form stage II 51- to 500-μm-diameter and then stage III >500μm-diameter metastases, which were encapsulated by collagenized fibrous septae. In the nodular growth pattern, CD133+ melanoma cells aggregated adjacent to portal venules and subsequently appeared to grow and efface the adjacent hepatocytes to form stage II 51- to 500-μm-diameter nodules that surrounded the portal venule. These avascular nodules appeared to further expand to form stage III >500-μm-diameter nodules that exhibited vascularization with minimal fibrosis. The tumor stem cell-like phenotype seen in individual UM cells was lost as the tumors progressed. There were CD56+ natural killer cells in sinusoidal spaces and CD3+ lymphocytes in periportal areas. The nodular growth pattern showed UM cells expressing MMP9 and VEGF. UM cells in both above-described growth patterns exhibited variable BAP1 expression. We propose that changes in the liver microenvironment are related to metastatic UM growth. We hypothesize that these changes include immune regulation within the sinusoidal space for the infiltrative pattern and changes in the VEGF/PEDF ratio for the nodular pattern.

Differential expression of TYRP1 in adult human retinal pigment epithelium and uveal melanoma cells

Uveal melanoma (UM) is the most frequently occurring primary intraocular malignancy in adults. Tyrosinase (TYR) is a copper-containing enzyme and a type I membrane protein that is involved in the generation of melanin, the main pigment in vertebrates. TYR-related protein 1 (TYRP1) is regarded to have a crucial role in the immunotherapy of melanoma. As biomarkers, the TYR-related proteins, TYRP1 and TYRP2, exhibit specific expression in melanocytes, while also contributing to melanin synthesis within melanosomes. In the present study, the differential expression of TYRP1 was investigated at the mRNA, protein and morphological levels in four human UM cell lines (SP6.5, OM431, OCM1 and OCM290) and the human retinal pigment epithelium (RPE) cell line, using polymerase chain reaction, western blotting, immunocytochemistry and immunofluorescence staining. It was found that SP6.5 cells expressed the highest level of TYRP1, in comparison to SP6.5 OCM1 and OM431 cells, which produced less TYRP1, and OCM290 cells, which produced almost no TYRP1. No TYRP1 protein expression was identified in the RPE cell line. These findings indicate the potential use of TYRP1 in the development of therapy for UM.

Progression of ocular melanoma metastasis to the liver: the 2012 Zimmerman lecture

IMPORTANCE

To the best of my knowledge, this study demonstrates for the first time small, apparently dormant micrometastasis in the liver of patients with uveal melanoma.

OBJECTIVE

To evaluate the histological and immunohistochemical findings in metastatic uveal melanoma to the liver.

DESIGN

Samples of liver were obtained at autopsy from patients who died of metastatic uveal melanoma to the liver.

SETTING

L. F. Montgomery Laboratory, Emory Eye Center, Atlanta, Georgia.

PARTICIPANTS

A total of 10 patients who died of metastatic uveal melanoma to the liver.

INTERVENTION

Sections of the liver were examined with hematoxylin-eosin, periodic acid-Schiff, Masson trichrome, or reticulin stains.

MAIN OUTCOME MEASURES

The tumors' morphology, growth pattern, mean vascular density, and mitotic index were determined with the aid of immunohistochemical stains for S100, HMB45, CD31, and Ki67.

RESULTS

Stage 1 metastases (defined as tumor clusters ≤50 μm in diameter) were identified in the sinusoidal spaces of 9 of 10 patients (90%). Stage 1 metastases were avascular and lacked mitotic activity. Stage 2 metastases (defined as tumors measuring 51-500 μm in diameter) and stage 3 metastases (defined as tumors measuring >500 μm in diameter) were found in all patients. Immunohistochemical stains were positive for S100 or HMB45 in all tumors. Overall, stage 1 metastases outnumbered stage 2 metastases (which outnumbered stage 3 metastases). The mean vascular density and mitotic index increased from stage 2 to stage 3 metastases (P < .05). The architecture of stage 2 metastases mimicked the surrounding hepatic parenchyma, whereas stage 3 metastases exhibited either lobular or portal growth patterns.

CONCLUSIONS

Uveal melanoma that spreads to the liver can be categorized as stage 1 (≤50 μm in diameter), stage 2 (51-500 μm in diameter), or stage 3 (>500 μm in diameter) metastases. The later stage exhibits a lobular or portal pattern of growth. During this progression, tumors become vascularized and mitotically active.

Cyclo-oxygenase-2 expression in photon-radiated and non-radiated uveal melanomas

PURPOSE

To determine and compare cyclo-oxygenase-2 (COX-2) expression in photon-radiated and non-radiated malignant uveal melanomas and to analyse the correlation between COX-2 expression and prognosis.

METHODS

Immunohistochemical staining for COX-2 was performed on 21 uveal melanomas that were endoresected after prior stereotactic radiotherapy with photons and on 22 tumours that were treated by endoresection without prior radiotherapy. COX-2 staining was further analysed in respect to cell type, maximal prominence, time interval between radiotherapy and surgery, apoptotic index (AI), proliferative index (PI) and the development of metastatic disease.

RESULTS

There was no difference in COX-2 expression between radiated and non-radiated melanomas (P>0.15). COX-2 staining correlated with neither the tumour prominence (P>0.40) nor the AI or the PI (both P>0.35). Tumours with high COX-2 expression were significantly more likely to develop metastasis (P=0.022).

CONCLUSION

Radiotherapy with photons does not induce COX-2 expression in malignant melanomas of the uvea. But high COX-2 expression may be a marker for poor prognosis.

Mobile phone use and risk of uveal melanoma: results of the risk factors for uveal melanoma case-control study

We recently reported an increased risk of uveal melanoma among mobile phone users. Here, we present the results of a case–control study that assessed the association between mobile phone use and risk of uveal melanoma. We recruited 459 uveal melanoma case patients at the University of Duisburg-Essen and matched 455 case patients with 827 population control subjects, 133 with 180 ophthalmologist control subjects, and 187 with 187 sibling control subjects. We used a questionnaire to assess mobile phone use and estimated odds ratios (ORs) and 95% confidence intervals (95% CIs) of risk for uveal melanoma using conditional logistic regression. Risk of uveal melanoma was not associated with regular mobile phone use (OR = 0.7, 95% CI = 0.5 to 1.0 vs population control subjects; OR = 1.1, 95% CI = 0.6 to 2.3 vs ophthalmologist control subjects; and OR = 1.2, 95% CI = 0.5 to 2.6 vs sibling control subjects), and we observed no trend for cumulative measures of exposure. We did not corroborate our previous results that showed an increased risk of uveal melanoma among regular mobile phone users.

Population-based incidence estimates of uveal melanoma in Germany. Supplementing cancer registry data by case–control data

Valid incidence rates of uveal melanoma (UM) from German population-based cancer registries are currently not available due to under-reporting. We conducted two case-control studies on UM at a reference centre for eye tumours and show the influence on population-based incidences of UM when data from case-control studies are linked with a cancer registry. The first case-control study (1996-1998) recruited 13 UM cases aged 35-74 years and the second case-control study (2002-2003) recruited 20 UM cases aged 20-74 residing within the population covered by the Münster Cancer Registry. After record linkage, age-truncated and standardized (World Standard Population) incidences with and without the record linkage were compared. Incidence rates based on routine cancer registration increased by a factor of 1.7 (1996-1998, age group 35-74 years) and 3.7 (2002-2003, age group 20-74 years) after record linkage with the case-control data. The supplemented age-standardized incidence of UM is 8.6 per million (20-74 years, 2002-2003) compared with the unsupplemented incidence of 2.3 per million. UM unknown to the registry were less often morphologically verified than those known to the registry. Cancer registries relying on pathology reports underestimate UM incidences if eye-preserving treatments are introduced. Close co-operation between cancer referral centres and cancer registries can substantially improve the completeness of registration.

Estimating the risk of malignant transformation of a choroidal nevus

PURPOSE

To estimate the risk of malignant transformation of a choroidal nevus in the white population.

DESIGN

Systematic literature review.

METHODS

A literature review was performed to obtain data on the prevalence of choroidal nevi in the white population. Data from studies that used indirect ophthalmoscopy or otherwise corrected data to include the entire fundus were selected. Only studies reporting on the United States population were included. The number of affected individuals was estimated using 2000 U.S. census data. The estimate of annual incident choroidal melanoma cases in the corresponding age- and race-matched population was calculated using the Surveillance, Epidemiology, and End Result database (1973-2000). Average annual age-specific incidence rates for 1973 to 2000 for each of the 5-year age groups (adjusted for the U.S. 2000 population) were calculated and applied to the corresponding census data. The ratio of numbers of affected individuals with choroidal melanoma and choroidal nevi gave the annual rate of malignant transformation of a choroidal nevus.

MAIN OUTCOME MEASURES

Annual rate of malignant transformation of a choroidal nevus in the white population of the U.S.

RESULTS

The prevalence of choroidal nevus in the white U.S. population ranged from 4.6% to 7.9%. It was estimated that, on average, 8864625 individuals in the U.S. had a choroidal nevus. The number of individuals with choroidal melanoma in the corresponding age- and race-matched population ranged from 989 to 1008 (mean, 1002). The annual rate of malignant transformation of a choroidal nevus was estimated to be 1 in 8845.

CONCLUSIONS

If it is assumed that all choroidal melanomas arise from preexisting nevi, then the published data suggest a low rate (1/8845) of malignant transformation of a choroidal nevus in the U.S. white population.

Incidence of noncutaneous melanomas in the U.S

BACKGROUND

Description of the epidemiology of noncutaneous melanoma has been hampered by its rarity. The current report was the largest in-depth descriptive analysis of incidence of noncutaneous melanoma in the United States, using data from the North American Association of Central Cancer Registries.

METHODS

Pooled data from 27 states and one metropolitan area were used to examine the incidence of noncutaneous melanoma by anatomic subsite, gender, age, race, and geography (northern/southern and coastal/noncoastal) for cases diagnosed between 1996 and 2000. Percent distribution by stage of disease at diagnosis and histology were also examined.

RESULTS

Between 1996 and 2000, 6691 cases of noncutaneous melanoma (4885 ocular and 1806 mucosal) were diagnosed among 851 million person-years at risk. Ocular melanoma was more common among men compared with women (6.8 cases per million men compared with 5.3 cases per million women, age-adjusted to the 2000 U.S. population standard), whereas mucosal melanoma was more common among women (2.8 cases per million women compared with 1.5 cases per million men). Rates of ocular melanoma among whites were greater than eight times higher than among blacks. Rates of mucosal melanoma were approximately two times higher among whites compared with blacks.

CONCLUSIONS

In contrast to cutaneous melanoma, there was no apparent pattern of increased noncutaneous melanoma among residents of southern or coastal states, with the exception of melanoma of the ciliary body and iris. Despite their shared cellular origins, both ocular and mucosal melanomas differ from cutaneous melanoma in terms of incidence by gender, race, and geographic area.

International uveal melanoma incidence trends in view of a decreasing proportion of morphological verification

The introduction of eye-preserving therapies for uveal melanoma in the 1970s complicates time trend analyses of the uveal melanoma incidence because the proportion of morphologically verified uveal melanoma has been decreasing over the decades. We carried out incidence trend analyses, based on data from internationally accredited population-based cancer registries throughout the world that take missing data on topography, morphology and basis of diagnosis of eye tumours into account. We selected incidence data of cancer registries that were included in Cancer Incidence In 5 Continents, Volumes VI-VIII covering a registration period of at least 15 years (usually 1983 to 1997) and classified each eye cancer as morphologically verified uveal melanoma, clinically diagnosed uveal melanoma, uveal melanoma identified as DCO case (Death certificate only), possibly uveal melanoma, other eye tumour or unclassifiable eye tumour and calculated age-standardized incidence rates by 3-year calendar periods using the World Standard Population as the reference. The uveal melanoma incidence decline in the United States SEER Caucasian population is due mainly to an incidence decline in the early registration period (from 1974-76 to 1986-88). The data from France and Italy suggest a recent increase in incidence. Uveal melanoma diagnosed clinically increasingly contribute to the overall uveal melanoma incidence over time. Combining all registries, the proportion of morphologically verified uveal melanoma decreased from 82% in 1983-87 to 75% in 1993-97. Uveal melanoma incidence rates remained quite stable during the period 1983-97. The interpretation of uveal melanoma incidence trends is complicated by missing data on topography within the eye, morphology and basis of diagnosis.