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McGrath LA, Warrier SK, Glasson WJ, D'Mellow MG, Hamilton HR, Palmer JM, Brooks KM, Johansson PA, Hayward NK. Iris melanoma in an Australian cohort. Clin Exp Ophthalmol 2024. [PMID: 39048918 DOI: 10.1111/ceo.14424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 06/23/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND To report the clinicopathological features and epidemiology of iris melanoma in Queensland, Australia. METHODS This was a retrospective study of 86 patients with iris melanoma treated between 2001 and 2022 at the Queensland Ocular Oncology Service, Brisbane, Australia. Main outcome measures included demographics, clinical and phenotypic features, age-adjusted incidence and relative survival. RESULTS Eighty-six patients (63% female) were included. Mean age was 54 years (range 17-82 years). The majority of patients (97%) were Caucasian, with blue eyes, fair skin and Fitzpatrick Skin Type I or II. Demographic features and clinical history showed a tendency for high ultraviolet radiation (UVR) exposure in the cohort. Histopathology was available in 69 cases (82%), and of these, 77% tumours were of spindle cell origin, with low-risk genetic profiles. Patients were followed for a mean of 8 years (median 7, range 1-21 years) after diagnosis, and only one case of metastasis was documented. CONCLUSIONS The association of iris freckles, history of UVR exposure and dermatologic findings supports the role of UVR in iris melanoma. Occupation and avocation history, as well as evaluation of iris freckles may offer an easily accessible way of stratifying the risk of an individual for development of UVR-related uveal melanoma.
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Affiliation(s)
- Lindsay A McGrath
- Terrace Eye Centre, Queensland Ocular Oncology Service, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Sunil K Warrier
- Terrace Eye Centre, Queensland Ocular Oncology Service, Brisbane, Australia
| | - William J Glasson
- Terrace Eye Centre, Queensland Ocular Oncology Service, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Matthew G D'Mellow
- Terrace Eye Centre, Queensland Ocular Oncology Service, Brisbane, Australia
- Oncogenomics Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Hayley R Hamilton
- Oncogenomics Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Jane M Palmer
- Oncogenomics Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Kelly M Brooks
- Oncogenomics Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Peter A Johansson
- School of Medicine, University of Queensland, Brisbane, Australia
- Oncogenomics Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Nicholas K Hayward
- Oncogenomics Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
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Naranpanawa N, Jayasinghe D, Sturm RA, Betz-Stablein B, Janda M, Eriksson A, Soyer HP, Chandra SS. Automated Detection of Pigmented Iris Freckles Using a Deep Neural Network for Cutaneous Melanoma Risk. J Invest Dermatol 2024:S0022-202X(24)00444-5. [PMID: 38823436 DOI: 10.1016/j.jid.2024.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/06/2024] [Accepted: 04/18/2024] [Indexed: 06/03/2024]
Affiliation(s)
- Nathasha Naranpanawa
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.
| | - Dilki Jayasinghe
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Richard A Sturm
- Frazer Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Australia
| | - Brigid Betz-Stablein
- Frazer Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Australia
| | - Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | - H Peter Soyer
- Frazer Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Australia
| | - Shekhar S Chandra
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
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Singh A, Melendez-Moreno A, Krohn J, Zabor EC. Predictive model for iris melanoma. Br J Ophthalmol 2024:bjo-2023-324558. [PMID: 38609162 DOI: 10.1136/bjo-2023-324558] [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: 09/13/2023] [Accepted: 03/17/2024] [Indexed: 04/14/2024]
Abstract
AimTo develop a predictive model for the diagnosis of iris melanoma. METHODS Retrospective consecutive case series that included 100 cases of pathologically confirmed iris melanoma and 112 cases of Iris naevus, either pathological confirmation or documented stability of >1 year. Patient demographic data, features of clinical presentation, tumour characteristics and follow-up were collected. Iris melanoma with ciliary body extension was excluded. Lasso logistic regression with 10-fold cross-validation was used to select the tuning parameter. Discrimination was assessed with the area under the curve (AUC) and calibration by a plot. RESULTS There was a significant asymmetry in the location of both nevi and melanoma with preference for inferior iris quadrants (83, 74%) and (79, 79%), respectively (p=0.50). Tumour seeding, glaucoma and hyphaema were present only in melanoma. The features that favoured the diagnosis of melanoma were size (increased height (OR 3.35); increased the largest basal diameter (OR 1.64)), pupillary distortion (ectropion uvea or corectopia (OR 2.55)), peripheral extension (angle or iris root involvement (OR 2.83)), secondary effects (pigment dispersion (OR 1.12)) and vascularity (OR 6.79). The optimism-corrected AUC was 0.865. The calibration plot indicated good calibration with most of the points falling near the identity line and the confidence band containing the identity line through most of the range of probabilities. CONCLUSIONS The predictive model provides direct diagnostic prediction of the lesion being iris melanoma expressed as probability (%). Use of a prediction calculator (app) can enhance decision-making and patient counselling. Further refinements can be undertaken with additional datasets, forming the basis for automated diagnosis.
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Affiliation(s)
- Arun Singh
- Department of Ophthalmic Oncology, Cleveland Clinic Main Campus Hospital, Cleveland, Ohio, USA
| | | | - Jørgen Krohn
- Department of Clinical Medicine, Bergen University College, Bergen, Norway
- Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway
| | - Emily C Zabor
- Department of Quantitative Health Sciences & Taussig Cancer Institute, Cleveland Clinic Main Campus Hospital, Cleveland, Ohio, USA
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Shemesh R, Bourla N, Vishnevskia-Dai V. Characteristics of amelanotic iris lesions - a ten-year historical cohort. Graefes Arch Clin Exp Ophthalmol 2024; 262:667-669. [PMID: 37486417 DOI: 10.1007/s00417-023-06183-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/08/2023] [Accepted: 07/17/2023] [Indexed: 07/25/2023] Open
Affiliation(s)
- Rachel Shemesh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Ocular Oncology, Goldschleger Eye Institute, Sheba Medical Center, 52621, Tel Hashomer, Israel.
| | - Nirit Bourla
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Ocular Oncology, Goldschleger Eye Institute, Sheba Medical Center, 52621, Tel Hashomer, Israel
| | - Vicktoria Vishnevskia-Dai
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Ocular Oncology, Goldschleger Eye Institute, Sheba Medical Center, 52621, Tel Hashomer, Israel.
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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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Pica A, Weber DC, Schweizer C, Chaouch A, Zografos L, Schalenbourg A. Clinical Outcomes in AYAs (Adolescents and Young Adults) Treated with Proton Therapy for Uveal Melanoma: A Comparative Matching Study with Elder Adults. Cancers (Basel) 2023; 15:4652. [PMID: 37760619 PMCID: PMC10526519 DOI: 10.3390/cancers15184652] [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: 07/28/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE The aim of this study was to compare the clinical outcomes of adolescents and young adults (AYAs) with those of elder adult patients treated with proton therapy (PT) for uveal melanoma (UM). MATERIAL AND METHODS A retrospective, comparative study was conducted in UM patients who underwent PT at the Ocular Oncology Unit of the Jules-Gonin Eye Hospital (University of Lausanne, Lausanne, Switzerland) and the Paul Scherrer Institute (PSI); (Villigen, Switzerland) between January 1997 and December 2007. Propensity score matching (PSM) was used to select for each AYA (between 15-39 years old) an elder adult patient (≥40 years) with similar characteristics. We assessed ocular follow-up, local tumor control, metastasis incidence, and overall and relative survival (OS and RS). Non-terminal outcomes were then compared between the two groups using competing risk survival analysis. RESULTS Out of a total of 2261 consecutive UM patients, after excluding 4 children (<15 years) and 6 patients who were metastatic at presentation, we identified 272 AYA patients and matched 270 of them with 270 elder adult patients. Before PSM, the AYA patients had a higher incidence of primary iris melanoma (4.0% vs. 1.4%; p = 0.005), while the elder patients were more likely to have other neoplastic diseases at presentation (9% vs. 3.7%; p = 0.004). Ocular outcomes and local tumor control were similar in both groups. Cumulative metastasis incidence for the AYA and elder adult groups was 13% and 7.9% at 5 years and 19.7% and 12.7% at 10 years, respectively, which was not significantly different between the groups (p = 0.214). The OS was similar in the two groups (p = 0.602), with estimates in the AYA and elder adult groups of 95.5% and 96.6% at 5 years and 94.6% and 91.4% at 10 years, respectively. However, the relative survival (RS) estimation was worse in the AYA group than the elder group (p = 0.036). CONCLUSION While AYAs treated with PT for UM have similar ocular outcomes and present the same metastasis incidence and OS as elder adults, their RS is worse than that in elder adults, when compared with the population in general.
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Affiliation(s)
- Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen West, Switzerland;
| | - Damien C. Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen West, Switzerland;
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
- Department of Radiation Oncology, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Claude Schweizer
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, FAA (Fondation Asile des Aveugles), 1004 Lausanne, Switzerland; (C.S.); (L.Z.); (A.S.)
| | - Aziz Chaouch
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1011 Lausanne, Switzerland;
| | - Leonidas Zografos
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, FAA (Fondation Asile des Aveugles), 1004 Lausanne, Switzerland; (C.S.); (L.Z.); (A.S.)
| | - Ann Schalenbourg
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, FAA (Fondation Asile des Aveugles), 1004 Lausanne, Switzerland; (C.S.); (L.Z.); (A.S.)
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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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