1
|
Shi H, Tian H, Zhu T, Chen J, Jia S, Zong C, Liao Q, Ruan J, Ge S, Rao Y, Dong M, Jia R, Li Y, Xu S, Fan X. Genetic landscape and prognosis of conjunctival melanoma in Chinese patients. Br J Ophthalmol 2024; 108:1306-1312. [PMID: 38383070 PMCID: PMC11347268 DOI: 10.1136/bjo-2023-324306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/18/2024] [Indexed: 02/23/2024]
Abstract
AIMS Conjunctival melanoma (CoM) is a rare but highly lethal ocular melanoma and there is limited understanding of its genetic background. To update the genetic landscape of CoM, whole-exome sequencing (WES) and targeted next-generation sequencing (NGS) were performed. METHODS Among 30 patients who were diagnosed and treated at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, from January 2018 to January 2023, WES was performed on 16 patients, while targeted NGS was conducted on 14 patients. Samples were analysed to identify the mutated genes, and the potential predictive factors for progression-free survival were evaluated. Furthermore, the expression of the mutated gene was detected and validated in a 30-patient cohort by immunofluorescence. RESULTS Mutations were verified in classic genes, such as BRAF (n=9), NRAS (n=5) and NF1 (n=6). Mutated FAT4 and BRAF were associated with an increased risk for the progression of CoM. Moreover, decreased expression of FAT4 was detected in CoM patients with a worse prognosis. CONCLUSIONS The molecular landscape of CoM in Chinese patients was updated with new findings. A relatively high frequency of mutated FAT4 was determined in Chinese CoM patients, and decreased expression of FAT4 was found in patients with worse prognoses. In addition, both BRAF mutations and FAT4 mutations could serve as predictive factors for CoM patients.
Collapse
Affiliation(s)
- Hanhan Shi
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Hao Tian
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Tianyu Zhu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jie Chen
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Shichong Jia
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Nankai University Affiliated Eye Hospital, Tianjin Eye Institute, Tianjin, China
| | - Chunyan Zong
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Qili Liao
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jing Ruan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Shengfang Ge
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yamin Rao
- Department of Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mei Dong
- The Core Laboratory in Medical Center of Clinical Research, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Renbing Jia
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yimin Li
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Shiqiong Xu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xianqun Fan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| |
Collapse
|
2
|
KAŠTELAN SNJEŽANA, PAVIČIĆ ANADIDOVIĆ, PAŠALIĆ DARIA, NIKUŠEVA-MARTIĆ TAMARA, ČANOVIĆ SAMIR, KOVAČEVIĆ PETRA, KONJEVODA SUZANA. Biological characteristics and clinical management of uveal and conjunctival melanoma. Oncol Res 2024; 32:1265-1285. [PMID: 39055896 PMCID: PMC11267116 DOI: 10.32604/or.2024.048437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/23/2024] [Indexed: 07/28/2024] Open
Abstract
Uveal and conjunctival melanomas are relatively rare tumors; nonetheless, they pose a significant risk of mortality for a large number of affected individuals. The pathogenesis of melanoma at different sites is very similar, however, the prognosis for patients with ocular melanoma remains unfavourable, primarily due to its distinctive genetic profile and tumor microenvironment. Regardless of considerable advances in understanding the genetic characteristics and biological behaviour, the treatment of uveal and conjunctival melanoma remains a formidable challenge. To enhance the prospect of success, collaborative efforts involving medical professionals and researchers in the fields of ocular biology and oncology are essential. Current data show a lack of well-designed randomized clinical trials and limited benefits in current forms of treatment for these tumors. Despite advancements in the development of effective melanoma therapeutic strategies, all current treatments for uveal melanoma (UM) and conjunctival melanoma (CoM) remain unsatisfactory, resulting in a poor long-term prognosis. Ongoing trials offer hope for positive outcomes in advanced and metastatic tumors. A more comprehensive understanding of the genetic and molecular abnormalities involved in the development and progression of ocular melanomas opens the way for the development of personalized therapy, with various potential therapeutic targets currently under consideration. Increased comprehension of the molecular pathogenesis of UM and CoM and their specificities may aid in the development of new and more effective systemic therapeutic agents, with the hope of improving the prognosis for patients with metastatic disease.
Collapse
Affiliation(s)
- SNJEŽANA KAŠTELAN
- School of Medicine, University of Zagreb, Zagreb, 10000, Croatia
- Department of Ophthalmology, Clinical Hospital Dubrava, Zagreb, 10000, Croatia
| | | | - DARIA PAŠALIĆ
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, School of Medicine, University of Zagreb, Zagreb, 10000, Croatia
| | - TAMARA NIKUŠEVA-MARTIĆ
- Department of Biology and Genetics, School of Medicine, University of Zagreb, Zagreb, 10000, Croatia
| | - SAMIR ČANOVIĆ
- Department of Ophthalmology, Zadar General Hospital, Zadar, 23000, Croatia
- Department of Health Studies, University of Zadar, Zadar, 23000, Croatia
| | - PETRA KOVAČEVIĆ
- School of Medicine, University of Zagreb, Zagreb, 10000, Croatia
- School of Medicine, University of Split, Split, 21000, Croatia
| | - SUZANA KONJEVODA
- Department of Ophthalmology, Zadar General Hospital, Zadar, 23000, Croatia
- Department of Health Studies, University of Zadar, Zadar, 23000, Croatia
| |
Collapse
|
3
|
Kharmach I, Rezzoug F, Moukhlissi M, Al Jarroudi O, Brahmi SA, Afqir S. Malignant Transformation of Reese's Melanosis: A Case of Conjunctival Melanoma and Related Therapeutic Modalities. Cureus 2024; 16:e62331. [PMID: 39006575 PMCID: PMC11246170 DOI: 10.7759/cureus.62331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/16/2024] Open
Abstract
Conjunctival melanoma is a rare but aggressive condition that can arise from healthy conjunctiva, pre-existing nevi, or precancerous conditions like Reese's melanosis. This acquired primary conjunctival melanosis can significantly impact an individual's quality of life due to its potential for recurrence and metastasis. Effective treatment typically requires a multidisciplinary approach to optimize outcomes. We present the case of a 56-year-old patient with recurrent Reese melanoma who underwent multiple surgeries. During the last intervention, a malignant transformation into melanoma was discovered. Due to the absence of brachytherapy facilities, the patient received local treatment with mitomycin C eye drops. Despite this limitation, the patient showed no signs of recurrence one year post-treatment. Given the high risk of local recurrence after surgery alone, additional radiotherapy is recommended and should be systematically discussed. Regular monitoring and timely intervention are essential to prevent disease progression. Notably, the frequent BRAF (B-Raf proto-oncogene, serine/threonine kinase) mutation in conjunctival melanoma opens possibilities for targeted therapies, such as BRAF inhibitors, offering promising options for management alongside traditional surgical approaches.
Collapse
Affiliation(s)
- Ikram Kharmach
- Medical Oncology, Mohammed VI University Hospital, Oujda, MAR
- Medical Oncology, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Fatima Rezzoug
- Medical Oncology, Mohammed VI University Hospital, Oujda, MAR
- Medical Oncology, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Mohamed Moukhlissi
- Radiotherapy, Mohammed VI University Hospital, Oujda, MAR
- Medical Oncology, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Ouissam Al Jarroudi
- Medical Oncology, Mohammed VI University Hospital, Oujda, MAR
- Medical Oncology, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Sami Aziz Brahmi
- Medical Oncology, Mohammed VI University Hospital, Oujda, MAR
- Medical Oncology, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Said Afqir
- Medical Oncology, Mohammed VI University Hospital, Oujda, MAR
- Medical Oncology, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| |
Collapse
|
4
|
Costea CF, Cucu AI, Dumitrescu GF, Sava S, Dimitriu G, Boţoc T, Popescu MR, Buzdugă CM, Dumitrescu AM, Stărică A, Macovei G, Prutianu I, Blaj LA, Tănase DM, Scripcariu DV. Epidemiological and histopathological aspects of ocular melanomas in Northeastern Romania. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2024; 65:35-44. [PMID: 38527982 PMCID: PMC11146456 DOI: 10.47162/rjme.65.1.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 03/22/2024] [Indexed: 03/27/2024]
Abstract
Ocular melanoma is a rare but complex disease in current medical practice. Our retrospective study spans over a period of 28 years and analyzed uveal and conjunctival melanomas that were consecutively admitted, diagnosed, and treated in the 2nd Ophthalmology Clinic of Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania. The patients were selected from the records of the Department of Pathology of our Hospital, being diagnosed by standard histopathological techniques. The aim of this study was to summarize the epidemiological and pathological aspects of uveal and conjunctival melanomas in Northeastern region of Romania. In our study, we did not notice a predilection of uveal and conjunctival melanoma to one particular gender. The most common histological subtypes of ocular melanomas were the heavily pigmented spindle cell subtype, followed by the epithelioid subtype. Our patients sought medical help in a timely manner, before the systemic invasion of the disease could develop.
Collapse
Affiliation(s)
- Claudia Florida Costea
- Department of Ophthalmology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
- 2nd Ophthalmology Clinic, Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania
| | - Andrei Ionuţ Cucu
- Department of Biomedical Sciences, Faculty of Medicine and Biological Sciences, Ştefan cel Mare University of Suceava, Romania
- 2nd Neurosurgery Clinic, Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania
| | | | - Sava Sava
- Department of Pathology, Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania
- Department of Anatomy, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Gabriela Dimitriu
- 2nd Ophthalmology Clinic, Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania
| | - Tina Boţoc
- 2nd Ophthalmology Clinic, Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania
| | - Mihaela Roxana Popescu
- Department of Radiology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Cătălin Mihai Buzdugă
- Department of Endocrinology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Ana Maria Dumitrescu
- Department of Anatomy, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Alexandra Stărică
- Department of Dermatology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Georgiana Macovei
- Department of Oral and Dental Diagnostics, Faculty of Dental Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Iulian Prutianu
- Department of Morpho-Functional Sciences I – Histology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Laurenţiu Andrei Blaj
- 2nd Neurosurgery Clinic, Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania
- Department of Neurosurgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Daniela Maria Tănase
- Department of Internal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Dragoş Viorel Scripcariu
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| |
Collapse
|
5
|
Chen K, McInnis-Smith K, Tiwari N, Moser JC, Ramasubramanian A. BRAF Immunohistochemical Studies of Pediatric Conjunctival Lesions. Cornea 2023; 42:1404-1407. [PMID: 36729648 DOI: 10.1097/ico.0000000000003196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/28/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this study was to analyze the prevalence of an activating mutation in the B-Raf proto-oncogene (BRAF) V600E immunoreactivity in pediatric conjunctival lesions. METHODS This retrospective case-control study included 32 pediatric patients who underwent surgical excision of conjunctival lesions between Jan 2019 and May 2022. The collected data included demographic data, clinical features, and histopathologic characteristics of the lesion, including BRAF V600E positivity. The Student t test and the Fisher exact test were used to determine the significance of the associations between clinical variables and BRAF positivity. RESULTS BRAF immunoreactivity was positive in 11/32 lesions (34%). Age at diagnosis did not correlate with BRAF positivity, with a mean age at diagnosis of 131.7 months for patients with BRAF+ lesions and 134.7 months for those with BRAF- lesions ( P > 0.1). No clinical or pathological features were found to be significantly correlated with BRAF positivity, although there was a trend toward BRAF positivity in the presence of cysts ( P = 0.072). CONCLUSIONS BRAF reactivity was present in approximately one-third of pediatric conjunctival nevi but does not correlate significantly with unique clinical or histopathological features.
Collapse
Affiliation(s)
| | | | | | - Justin C Moser
- HonorHealth Research and Innovation Institute, Scottsdale, AZ
| | | |
Collapse
|
6
|
Alves M, Asbell P, Dogru M, Giannaccare G, Grau A, Gregory D, Kim DH, Marini MC, Ngo W, Nowinska A, Saldanha IJ, Villani E, Wakamatsu TH, Yu M, Stapleton F. TFOS Lifestyle Report: Impact of environmental conditions on the ocular surface. Ocul Surf 2023; 29:1-52. [PMID: 37062427 DOI: 10.1016/j.jtos.2023.04.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
Environmental risk factors that have an impact on the ocular surface were reviewed and associations with age and sex, race/ethnicity, geographical area, seasonality, prevalence and possible interactions between risk factors are reviewed. Environmental factors can be (a) climate-related: temperature, humidity, wind speed, altitude, dew point, ultraviolet light, and allergen or (b) outdoor and indoor pollution: gases, particulate matter, and other sources of airborne pollutants. Temperature affects ocular surface homeostasis directly and indirectly, precipitating ocular surface diseases and/or symptoms, including trachoma. Humidity is negatively associated with dry eye disease. There is little data on wind speed and dewpoint. High altitude and ultraviolet light exposure are associated with pterygium, ocular surface degenerations and neoplastic disease. Pollution is associated with dry eye disease and conjunctivitis. Primary Sjögren syndrome is associated with exposure to chemical solvents. Living within a potential zone of active volcanic eruption is associated with eye irritation. Indoor pollution, "sick" building or house can also be associated with eye irritation. Most ocular surface conditions are multifactorial, and several environmental factors may contribute to specific diseases. A systematic review was conducted to answer the following research question: "What are the associations between outdoor environment pollution and signs or symptoms of dry eye disease in humans?" Dry eye disease is associated with air pollution (from NO2) and soil pollution (from chromium), but not from air pollution from CO or PM10. Future research should adequately account for confounders, follow up over time, and report results separately for ocular surface findings, including signs and symptoms.
Collapse
Affiliation(s)
- Monica Alves
- Department of Ophthalmology and Otorhinolaryngology, University of Campinas Campinas, Brazil.
| | - Penny Asbell
- Department of Bioengineering, University of Memphis, Memphis, USA
| | - Murat Dogru
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Graecia of Catanzaro, Cantanzaro, Italy
| | - Arturo Grau
- Department of Ophthalmology, Pontifical Catholic University of Chile, Santiago, Chile
| | - Darren Gregory
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, USA
| | - Dong Hyun Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
| | | | - William Ngo
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Anna Nowinska
- Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Ian J Saldanha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Edoardo Villani
- Department of Clinical Sciences and Community Health, University of Milan, Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Tais Hitomi Wakamatsu
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, São Paulo Hospital, Federal University of São Paulo, Brazil
| | - Mitasha Yu
- Sensory Functions, Disability and Rehabilitation Unit, World Health Organization, Geneva, Switzerland
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| |
Collapse
|
7
|
Actualities in the Morphology and Immunohistochemistry of Cutaneous and Ocular Melanoma: What Lies Ahead? A Single-Centre Study. Biomedicines 2022; 10:biomedicines10102500. [PMID: 36289768 PMCID: PMC9599614 DOI: 10.3390/biomedicines10102500] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 11/16/2022] Open
Abstract
Melanoma is the most aggressive melanocytic tumor whose incidence is continuously increasing worldwide. METHODS We highlight the morphological, immunohistochemistry, and particularities of various melanoma types based on the cases diagnosed in our department from 2017 to 2021. RESULTS We present 100 melanoma cases and one capsular nevus case. The most common type was nodular melanoma. The immunohistochemistry markers used were SRY-box transcription factor 10 (SOX10), S100 protein, human melanoma black 45 (HMB45), and melanoma antigen recognized by T cells 1 (Melan-A). Uveal melanoma and conjunctival melanoma represent particular tumors with independent prognostic factors. Uveal melanoma requires assessment of macrophages, microvascularisation, and mitoses. Sentinel lymph node metastases are essential targets that provide staging tools. Conjunctival melanoma and capsular nevi are diagnostic pitfalls. CONCLUSION Melanoma can appear in various forms, and sometimes the diagnosis might be unclear. Today, immunohistochemistry remains the most important tool in confirming the diagnosis and prognosis for this type of neoplasia.
Collapse
|
8
|
Cid-Bertomeu P, Huerva V. Use of interferon alpha 2b to manage conjunctival primary acquired melanosis and conjunctival melanoma. Surv Ophthalmol 2022; 67:1391-1404. [PMID: 35278438 DOI: 10.1016/j.survophthal.2022.03.003] [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: 10/21/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
Primary acquired melanosis (PAM) is acquired conjunctival pigmentation that can give rise to conjunctival melanoma (CM), a malignant tumor of the bulbar and palpebral conjunctiva or the caruncle. Surgical excision is the treatment of choice for this neoplasm. Topical chemotherapy is also used for patients with PAM with atypia or CM, hand in patients with recurrent or extensive disease, this may be an important option. Of the several chemotherapeutic drugs used, topical interferon alpha 2b (IFN-α2b) has become popular because of its low toxicity. Clinical evidence from case reports and case series supports the efficacy of IFN-α2b as the preferred adjuvant treatment for PAM and CM. In addition, topical IFN-α2b has been successfully applied to melanocytic tumors refractory to other treatments, such as cryotherapy and topical mitomycin C. In patients with locally advanced CM, the combination of IFN-α2b and systemic immunotherapy may serve as an alternative to exenteration. Given the low frequency of CM, long-term multicenter studies are needed to demonstrate the efficacy of IFN-α2b for preventing local recurrence and distant metastasis.
Collapse
Affiliation(s)
- Pau Cid-Bertomeu
- Department of Ophthalmology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Valentín Huerva
- Department of Ophthalmology, University Hospital Arnau de Vilanova, Lleida, Spain.; School of Medicine, University of Lleida, Lleida, Spain.; Biomedical Research Institute of Lleida, University of Lleida, Lleida, Spain..
| |
Collapse
|
9
|
Brouwer NJ, Verdijk RM, Heegaard S, Marinkovic M, Esmaeli B, Jager MJ. Conjunctival melanoma: New insights in tumour genetics and immunology, leading to new therapeutic options. Prog Retin Eye Res 2021; 86:100971. [PMID: 34015548 DOI: 10.1016/j.preteyeres.2021.100971] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 12/14/2022]
Abstract
Recent developments in oncology have led to a better molecular and cellular understanding of cancer, and the introduction of novel therapies. Conjunctival melanoma (CoM) is a rare but potentially devastating disease. A better understanding of CoM, leading to the development of novel therapies, is urgently needed. CoM is characterized by mutations that have also been identified in cutaneous melanoma, e.g. in BRAF, NRAS and TERT. These mutations are distinct from the mutations found in uveal melanoma (UM), affecting genes such as GNAQ, GNA11, and BAP1. Targeted therapies that are successful in cutaneous melanoma may therefore be useful in CoM. A recent breakthrough in the treatment of patients with metastatic cutaneous melanoma was the development of immunotherapy. While immunotherapy is currently sparsely effective in intraocular tumours such as UM, the similarities between CoM and cutaneous melanoma (including in their immunological tumour micro environment) provide hope for the application of immunotherapy in CoM, and preliminary clinical data are indeed emerging to support this use. This review aims to provide a comprehensive overview of the current knowledge regarding CoM, with a focus on the genetic and immunologic understanding. We elaborate on the distinct position of CoM in contrast to other types of melanoma, and explain how new insights in the pathophysiology of this disease guide the development of new, personalized, treatments.
Collapse
Affiliation(s)
- Niels J Brouwer
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Robert M Verdijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands; Department of Pathology, Leiden University Medica Center, Leiden, the Netherlands; Department of Pathology, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Pathology, Eye Pathology Section, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Marina Marinkovic
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Bita Esmaeli
- Department of Plastic Surgery, Orbital Oncology and Ophthalmic Plastic Surgery, M.D. Anderson Cancer Center, Houston, TX, USA.
| | - Martine J Jager
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.
| |
Collapse
|
10
|
In-vivo imaging for assessing tumor growth in mouse models of ocular melanoma. Exp Eye Res 2021; 204:108431. [PMID: 33406396 DOI: 10.1016/j.exer.2020.108431] [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: 08/18/2020] [Revised: 11/11/2020] [Accepted: 12/28/2020] [Indexed: 12/14/2022]
Abstract
Uveal melanoma (UM) and conjunctival melanoma (CM) are ocular malignancies that give rise to life-threatening metastases. Although local disease can often be treated successfully, it is often associated with significant vision impairment and treatments are often not effective against metastatic disease. Novel treatment modalities that preserve vision may enable elimination of small tumors and may prevent subsequent metastatic spread. Very few mouse models of metastatic CM and UM are available for research and for development of novel therapies. One of the challenges is to follow tumor growth in-vivo and to determine the right size for treatment, mainly of the posterior, choroidal melanoma. Hence, the purpose of this study was to establish a simple, noninvasive imaging tool that will simplify visualization and tumor follow-up in mouse models of CM and UM. Tumors were induced by inoculation of murine B16LS9 cells into the sub-conjunctival or the choroidal space of a C57BL/6 mouse eye under a surgical microscope. Five to ten days following injection, tumor size was assessed by Phoenix MicronIV™ image-guided Optical Coherence Tomography (OCT) imaging, which included a real-time camera view and OCT scan of the conjunctiva and the retina. In addition, tumor size was evaluated by ultrasound and histopathological examination of eye sections. Tumor growth was observed 5-9 days following sub-conjunctival or sub-retinal injection of seven-thousand or seventy-thousand cells, respectively. A clear tumor mass was detected at these regions using the MicronIV™ imaging system camera and OCT scans. Histology of eye sections confirmed the presence of tumor tissue. OCT allowed an accurate measurement of tumor size in the UM model and a qualitative assessment of tumor size in the CM model. Moreover, OCT enabled assessing the success rate of the choroidal tumor induction and importantly, predicted final tumor size already on the day of cell inoculation. In conclusion, by using a simple, non-invasive imaging tool, we were able to follow intraocular tumor growth of both CM and UM, and to define, already at the time of cell inoculation, a grading scale to evaluate tumor size. This tool may be utilized for evaluation of new mouse models for CM and UM, as well as for testing new therapies for these diseases.
Collapse
|
11
|
Koç İ, Kıratlı H. Current Management of Conjunctival Melanoma Part 1: Clinical Features, Diagnosis and Histopathology. Turk J Ophthalmol 2020; 50:293-303. [PMID: 33342197 PMCID: PMC7610047 DOI: 10.4274/tjo.galenos.2020.38096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Conjunctival melanoma is a rare disease which makes up approximately 5% of ocular melanomas. The lesion may occur de novo or originate from a pre-existing nevus or primary acquired melanosis. Biomicroscopy is of paramount importance in diagnosis and follow-up of the disease, while other diagnostic modalities serve as supplementary tools. Many clinical and histopathological risk factors have been reported for prognosis. This review aims to address the clinical findings, differential diagnosis, diagnostic tools, prognostic factors, and staging of this disease.
Collapse
Affiliation(s)
- İrem Koç
- Hacettepe University Faculty of Medicine, Department of Ophthalmology, Ocular Oncology Service, Ankara, Turkey
| | - Hayyam Kıratlı
- Hacettepe University Faculty of Medicine, Department of Ophthalmology, Ocular Oncology Service, Ankara, Turkey
| |
Collapse
|
12
|
Zeng Y, Hu C, Shu L, Pan Y, Zhao L, Pu X, Wu F. Clinical treatment options for early-stage and advanced conjunctival melanoma. Surv Ophthalmol 2020; 66:461-470. [PMID: 32980421 DOI: 10.1016/j.survophthal.2020.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 12/13/2022]
Abstract
Conjunctival melanoma (CM) is an ocular malignant tumor arising from the bulbar and palpebral conjunctiva and from the caruncle. The treatment of early-stage CM is wide local excision, followed by cryotherapy to the margins and adjuvant therapy postoperatively. Advanced CM has a poor prognosis, and there is no consensus on its management. With the development of precision medicine, the identification of genetic alterations assumes great importance. The genetic characteristics of CM, such as BRAF, NRAS, and NF1 mutations, may provide potential therapeutic targets. For locally advanced tumors and metastatic disease, targeted therapy such as BRAF inhibitors and MEK inhibitors in vitro show therapeutic benefit. Some individual case reports indicate their potential effectiveness in advanced CM. In addition, immune checkpoint inhibitors, such as programmed cell death-1 and cytotoxic T lymphocyte antigen-4 inhibitors, have been successfully used for advanced cutaneous melanoma and may be effective in CM. Limited clinical case reports found immune checkpoint inhibitors effective in advanced CM. More clinical studies are needed.
Collapse
Affiliation(s)
- Yue Zeng
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chunhong Hu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Long Shu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yue Pan
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lishu Zhao
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xingxiang Pu
- Department of Thoracic Medical Oncology, Hunan Cancer Hospital/the affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Fang Wu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
| |
Collapse
|
13
|
Balzer BWR, Cherepanoff S, Joshua AM, Giblin M, Conway RM, Anazodo AC. Conjunctival Melanoma in Childhood and Adolescence: A Systematic Review. Ocul Oncol Pathol 2019; 5:387-395. [PMID: 31768361 DOI: 10.1159/000497813] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/08/2019] [Indexed: 12/15/2022] Open
Abstract
Background Conjunctival melanoma is rare in adults and rarer in children. We systematically reviewed the presentation, diagnostic and management strategies as well as outcomes for conjunctival melanoma in children and adolescents. Methods The following databases were searched: Medline, Embase, Web of Science and Scopus for cases of conjunctival melanoma occurring in children and adolescents < 18 years of age. Results Seventeen studies with 32 patients (18 males) were identified. The median age at presentation was 11 years (range 4-18 years). Most patients were white. Most patients presented with a conjunctival mass or naevus with a recent history of growth or change. Excision biopsy provided diagnosis and management for all cases. Adjuvant chemotherapy and radiotherapy were also used. One patient had metastatic disease at diagnosis and 3 developed metastatic disease (range 1-10 months). Two patients died from disease and one was alive with metastatic disease. Two patients had disease recurrence. Outcomes were observed to be better where diagnosis was made earlier and "no-touch" excision biopsy was performed in an appropriate specialist setting. Conclusions Conjunctival melanoma occurs rarely in children and adolescents. Surgery is the mainstay of management. The prognosis is guarded in metastatic disease due to the small sample size and limited follow-up.
Collapse
Affiliation(s)
- Ben W R Balzer
- Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Svetlana Cherepanoff
- St. Vincent's Hospital, Darlinghurst, New South Wales, Australia.,Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Anthony M Joshua
- St. Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | | | - Robert Max Conway
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Antoinette C Anazodo
- Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia.,Kid's Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| |
Collapse
|
14
|
Scholz SL, Hérault J, Stang A, Griewank KG, Meller D, Thariat J, Steuhl KP, Westekemper H, Sauerwein W. Proton radiotherapy in advanced malignant melanoma of the conjunctiva. Graefes Arch Clin Exp Ophthalmol 2019; 257:1309-1318. [DOI: 10.1007/s00417-019-04286-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 02/21/2019] [Accepted: 03/03/2019] [Indexed: 11/29/2022] Open
|
15
|
Conjunctival Melanoma - Epidemiological Trends and Features. Pathol Oncol Res 2018; 24:787-796. [PMID: 29802540 DOI: 10.1007/s12253-018-0419-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 05/14/2018] [Indexed: 12/11/2022]
Abstract
Conjunctival melanoma is a rare but sight and life threatening malignancy. It accounts for 2%-5% of all ocular tumours and 5%-7% of all ocular melanomas with an incidence of 0.2-0.8 per million in the Caucasian population with rare cases reported in the non-Caucasians. In recent decades the incidence of uveal melanoma has been relatively stable whilst conjunctival and cutaneous melanoma have shown increasing incidence which may be connected to the result of environmental exposure to ultraviolet light. The dissimilarity in incidence between light and dark pigmented individuals observed in conjunctival melanomas compared to uveal and cutaneous melanomas may be related to differences in their histological structures and genetic profile. Recent molecular biological studies support the fact that each type of melanoma undergoes its own molecular changes and has characteristic biological behaviour. Further studies are required for each type of melanoma in order to ascertain their individual etiology and pathogenesis and based on this knowledge develop relevant preventative and treatment procedures.
Collapse
|
16
|
Dehghani S, Rasoulianboroujeni M, Ghasemi H, Keshel SH, Nozarian Z, Hashemian MN, Zarei-Ghanavati M, Latifi G, Ghaffari R, Cui Z, Ye H, Tayebi L. 3D-Printed membrane as an alternative to amniotic membrane for ocular surface/conjunctival defect reconstruction: An in vitro & in vivo study. Biomaterials 2018; 174:95-112. [PMID: 29793112 DOI: 10.1016/j.biomaterials.2018.05.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/06/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the surgical handling and clinical applicability of a specific 3D-printed membrane design fabricated using a gelatin, elastin and sodium hyaluronate blend for conjunctival reconstruction and compare it with amniotic membrane (AM), which is normally used in such surgeries. METHODS 3D printing technique was employed to fabricate the membrane based on gradient design. Prior to printing, rheometry was employed to optimize the ink composition. The printed membranes were then fully characterized in terms of physical and mechanical properties. In vitro viability, proliferation and adhesion of human limbal epithelial cells were assessed using MTT assay and scanning electron microscopy (SEM), respectively. Prior to in vivo experiment, surgical handling of each membrane was evaluated by three surgeons. In vivo evaluation was conducted through implanting the gelatin-based membranes and AM on induced conjunctival defects in rabbits (n = 8). Clinical observations, including epithelialization, inflammation severity, scar tissue formation and presence of granulation tissue, were recorded from day 1 through day 28. Histological examination was performed on all enucleated eyes on day 28. In addition to H&E staining, specific stains including Periodic Acid Schiff staining, Masson's Trichrome staining and immuno-histochemical staining for α-SMA were further used to assess goblet cell proliferation, healed sub-epithelial stroma and scar tissue formation and the presence of myofibroblasts, respectively. RESULTS Among all the examined compositions, a blend of 8% w/v gelatin, 2% w/v elastin and 0.5% w/v sodium hyaluronate was found to be appropriate for printing. The printed membranes had favorable optical characteristics (colorless and transparent), and the surgical handling was significantly easier compared to AM. Epithelial cells cultivated on the membranes indicated suitable viability and proliferation, and SEM images presented appropriate cell adhesion on the surface of the membranes. Clinical observations suggested similar epithelialization time (approximately 3 weeks) for both the membrane and AM grafted eyes but significantly lower levels of clinical inflammation in the membrane group from day 1 through day 28 (p = 0.01), which is a key advantage of using the printed membranes over the AM. Histological examination showed similar qualities in the healed epithelium in terms of cell morphology and cell layers. However, twice the density of goblet cells per 100 cells was observed in the gelatin-based membrane grafted group. Remnant of the degraded implant was seen in only 3 of the membranes, but in 7 of the AM grafted eyes. Inflammation and granulomatous reaction was significantly higher in sections containing the AM compared to membrane (p < 0.01 and p = 0.01, respectively). α-SMA staining was more evident, but not significantly different from the gelatin-based membrane, for the AM group (p = 0.25). CONCLUSION The designed gelatin-based membrane offers the necessary physical and mechanical characteristics needed for successful ocular surface/conjunctival defect construction and may be considered a promising alternative to AM due to a more predictable degradation pattern, higher goblet cell density on the healed epithelium, less inflammation and reduced scar tissue formation.
Collapse
Affiliation(s)
- Shima Dehghani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hamed Ghasemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Saeed Heidari Keshel
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Nozarian
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mehran Zarei-Ghanavati
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Golshan Latifi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Ghaffari
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zhanfeng Cui
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, OX1 3PJ, UK
| | - Hua Ye
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, OX1 3PJ, UK.
| | - Lobat Tayebi
- Marquette University School of Dentistry, Milwaukee, WI 53233, USA; Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, OX1 3PJ, UK.
| |
Collapse
|
17
|
Conjunctival melanoma: association of cyclooxygenase-2 tumor expression to prognosis. Graefes Arch Clin Exp Ophthalmol 2018; 256:989-995. [DOI: 10.1007/s00417-017-3864-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 11/11/2017] [Accepted: 12/11/2017] [Indexed: 02/07/2023] Open
|
18
|
Klefter ON, Rasmussen MLR, Toft PB, Heegaard S. Therapeutic options for conjunctival neoplasia. EXPERT REVIEW OF OPHTHALMOLOGY 2018. [DOI: 10.1080/17469899.2018.1417840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Oliver Niels Klefter
- Department of Ophthalmology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Peter Bjerre Toft
- Department of Ophthalmology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Pathology, Eye Pathology Section, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
19
|
Walters AR, Keck KM, Simmons O, Williams SG, Cross S, Patel RM. Malignant melanoma presenting as amelanotic caruncular lesion in a child. J AAPOS 2017; 21:501-503. [PMID: 29126970 DOI: 10.1016/j.jaapos.2017.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 06/15/2017] [Accepted: 06/22/2017] [Indexed: 12/24/2022]
Abstract
Conjunctival melanoma is a rare malignant neoplasm that can present in childhood in any part of the conjunctiva. The infrequency with which conjunctival melanoma is encountered in childhood caruncular lesions makes it a formidable but important aspect of the differential diagnosis. We report the case of a 10-year-old boy who presented with a left caruncular lesion. On histopathologic analysis, the lesion was determined to be BRAF-negative invasive melanoma arising in association with melanocytic nevus. The melanoma was excised using no-touch technique and double freeze thaw cryotherapy. A full systemic work-up revealed no metastasis or abnormality.
Collapse
Affiliation(s)
- Alexander R Walters
- Department of Ophthalmology, Palmetto Health/University of South Carolina, Richland
| | - Katie M Keck
- Department of Ophthalmology, Palmetto Health/University of South Carolina, Richland.
| | - Oliver Simmons
- Department of Otolaryngology, Palmetto Health/University of South Carolina, Richland
| | - Sarah G Williams
- Department of Pathology, Palmetto Health/University of South Carolina, Richland
| | - Stephen Cross
- Department of Ophthalmology, Palmetto Health/University of South Carolina, Richland
| | - Rakesh M Patel
- Department of Ophthalmology, Palmetto Health/University of South Carolina, Richland
| |
Collapse
|
20
|
Brouwer NJ, Marinkovic M, van Duinen SG, Bleeker JC, Jager MJ, Luyten GPM. Treatment of conjunctival melanoma in a Dutch referral centre. Br J Ophthalmol 2017; 102:1277-1282. [PMID: 29122819 DOI: 10.1136/bjophthalmol-2017-311082] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 02/03/2023]
Abstract
AIMS To evaluate the treatment of conjunctival melanoma at a large Dutch referral centre and to make recommendations for clinical management. METHODS A retrospective review was performed of clinical and histological data of 70 patients treated for a primary conjunctival melanoma between 2001 and 2014 at the Leiden University Medical Center, Leiden, the Netherlands. Detailed follow-up data were available for all patients. RESULTS The mean follow-up time was 70.2 months. The overall 5-year recurrence rate was 29%, the 5-year metastasis rate 12% and the 5-year melanoma-related survival 90%. Treatment with excision alone had a significantly higher 5-year recurrence rate than (the combination of) other treatments (HR 3.73,95% CI 1.19 to 11.6, P=0.02). Initial treatment in an ocular oncology centre was associated with fewer recurrences compared with initial treatment by a local ophthalmologist of a referring centre (HR 0.32,95% CI 0.11 to 0.94, P=0.04), despite similar tumour baseline characteristics. CONCLUSION Conjunctival melanoma is a rare disease with a high recurrence rate. A treatment strategy with local excision and adjuvant therapy gave a good clinical outcome, excision alone as a treatment should be considered obsolete. Initial treatment in a large referral centre improves clinical outcome, and patients should be referred to a specialised centre as soon as possible.
Collapse
Affiliation(s)
- Niels J Brouwer
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marina Marinkovic
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sjoerd G van Duinen
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaco C Bleeker
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martine J Jager
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gregorius P M Luyten
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
21
|
Mahendraraj K, Shrestha S, Lau CS, Chamberlain RS. Ocular melanoma-when you have seen one, you have not seen them all: a clinical outcome study from the Surveillance, Epidemiology and End Results (SEER) database (1973-2012). Clin Ophthalmol 2017; 11:153-160. [PMID: 28115829 PMCID: PMC5221652 DOI: 10.2147/opth.s120530] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Ocular melanoma (OM) comprises <5% of all melanomas. Uveal melanoma (UM) is the most common subtype of OM, while conjunctival melanoma (CM) is rare and differs significantly from UM. The purpose of this study is to evaluate a large cohort of OM patients to differentiate demographic, pathologic, and clinical factors between these two neoplasms, which may affect treatment and outcomes. METHODS The Surveillance, Epidemiology, and End Results database (1973-2012) was used to extract demographic and clinical data on 8,165 OM patients (92.1% UM and 7.9% CM). RESULTS Both CM and UM were most prevalent among Caucasian males in the seventh decade of life. UM patients presented more often with localized disease (90.9% vs 81.2, P<0.01). Surgery (42.8%), radiation (43.0%), or combined surgery and radiation (7.0%) were used in the treatment of UM, while CM was treated almost exclusively with surgery (88.7%). Mean overall survival was longer (15.4 vs 14.6 years; P<0.01) and mortality rates were lower in patients (38.8% vs 46.1%; P<0.01) with CM. CONCLUSION Despite presenting with more advanced disease than UM, CM is associated with an increased overall survival. Surgery is the primary therapy for CM, whereas radiotherapy is the primary therapy for UM and is associated with prolonged survival.
Collapse
Affiliation(s)
| | - Sneha Shrestha
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA
| | - Christine Sm Lau
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; Saint George's University School of Medicine, Grenada, West Indies
| | - Ronald S Chamberlain
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; Saint George's University School of Medicine, Grenada, West Indies; Department of Surgery, Banner MD Anderson Cancer Center, Gilbert, AZ, USA; Department of Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| |
Collapse
|
22
|
Kanavi MR, Hosseini SB, Aliakbar-Navahi R, Aghaei H. Impression Cytology in a Series of Clinically Diagnosed Ocular Surface Melanocytic Lesions. J Ophthalmic Vis Res 2017; 12:17-22. [PMID: 28299002 PMCID: PMC5340058 DOI: 10.4103/jovr.jovr_72_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To report impression cytology (IC) results of clinically diagnosed ocular surface melanocytic lesions. METHODS Ten patients with a clinical diagnosis of an ocular surface melanocytic lesion underwent IC using cellulose acetate strips and Periodic acid Schiff-Papanicolaou staining. Excisional biopsy of lesions was performed in case of observing atypical cells on IC or at the patient's request, and excised specimens were subjected to histopathological analysis. Agreement between clinical diagnoses and IC results and between IC results and histopathology were evaluated. RESULTS Clinical diagnoses were nevi in 6, primary acquired melanosis (PAM) with atypia/melanoma in 2, and atypical nevus versus pigmented conjunctival intraepithelial neoplasia (CIN) in 2 cases. IC results were suggestive of a benign nevus in 7, PAM with atypia/melanoma in 2 and CIN versus an atypical epithelioid type melanocytic lesion in 1 case. IC results were consistent with the clinical diagnoses in 9 cases (Cohen's kappa index of 0.83) and excluded CIN in 1. Histopathology in 6 cases disclosed benign melanonevus in 3, malignant melanoma in the context of PAM with atypia in 2, and CIN in 1 case. Histologic results were well correlated with the IC features (Cohen's kappa index of 0.74). CONCLUSION By demonstrating typical cytomorphological features of ocular superficial layers IC diagnosed the true nature of melanocytic ocular surface lesions in the majority of cases. Although IC does not substitute histopathology, given the high correlation between IC results and histopathology, it can be of great assistance in diagnosis and management of ocular surface melanocytic lesions.
Collapse
Affiliation(s)
- Mozhgan Rezaei Kanavi
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Bagher Hosseini
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Central Eye Bank of Iran, Tehran, Iran
| | | | - Hossein Aghaei
- Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
23
|
Westekemper H, Meller D, Darawsha R, Scholz SL, Flühs D, Steuhl KP, Hérault J, Thariat J, Sauerwein W. [Operative therapy and irradiation of conjunctival melanoma]. Ophthalmologe 2016; 112:899-900, 902-6. [PMID: 26475337 DOI: 10.1007/s00347-015-0147-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Radiotherapy of conjunctival melanoma has gained in importance in recent years compared to less invasive therapeutic approaches. This is due to the high recurrence rates achieved by omitting adjuvant therapy and to the increasing availability of suitable radiotherapeutic methods, so that tumors formerly not amenable to organ-preserving therapy can now be treated. OBJECTIVE This article presents the current radiotherapeutic options for conjunctival melanoma. The aim is to describe the diagnostic and therapeutic strategies and the course of therapy of malignant conjunctival melanoma. It is the authors' intention to justify the necessity of the adjuvant therapy of conjunctival melanoma and to emphasize the need for interdisciplinary cooperation during the course of tumor therapy. METHODS The article is based on results published in the literature as well as on data collected and experience gained in our centre.
Collapse
Affiliation(s)
- H Westekemper
- Klinik für Erkrankungen des vorderen Augenabschnitts, Zentrum für Augenheilkunde, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - D Meller
- Klinik für Erkrankungen des vorderen Augenabschnitts, Zentrum für Augenheilkunde, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - R Darawsha
- Klinik für Erkrankungen des vorderen Augenabschnitts, Zentrum für Augenheilkunde, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - S L Scholz
- Klinik für Erkrankungen des vorderen Augenabschnitts, Zentrum für Augenheilkunde, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - D Flühs
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - K-P Steuhl
- Klinik für Erkrankungen des vorderen Augenabschnitts, Zentrum für Augenheilkunde, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - J Hérault
- Cyclotron Biomédical, Centre Antoine-Lacassagne, Nice, France
| | - J Thariat
- Cyclotron Biomédical, Centre Antoine-Lacassagne, Nice, France
| | - W Sauerwein
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| |
Collapse
|
24
|
Abstract
BACKGROUND Despite microscopically controlled tumor excision, malignant melanomas of the conjunctiva have a propensity for local recurrence, lymphatic spread and distant metastases. OBJECTIVES This review outlines the options of adjuvant therapy as well as the structure of interdisciplinary follow-up care for patients with conjunctival melanoma. METHODS The study provides a PubMed literature review and own clinical results. RESULTS In conjunctival melanoma complete tumor excision using a minimal touch technique should always be combined with adjuvant therapy, such as cryotherapy, radiotherapy, topical chemotherapy and/or immunotherapy. For locally circumscribed lesions of the bulbar conjunctiva adjuvant brachytherapy can be supplemented and for non-bulbar, extensive, diffuse or multilocular tumor growth, complementary adjuvant topical mitomycin C therapy or proton radiotherapy can be used. Novel adjuvant approaches include topical interferon alpha-2b immunotherapy, topical vascular endothelial growth factor (VEGF) inhibitors or in cases of BRAF mutations personalized therapy using selective BRAF inhibitors or in combination with mitogen-activated protein kinase (MAPK) and extracellular signal-regulated kinase (ERK), MAPK/ERK (MEK) inhibitors. All patients should be integrated into an interdisciplinary follow-up care program including quarter yearly checkups in the first 5 years and psycho-oncological healthcare. CONCLUSION Following microscopically controlled tumor excision, adjuvant treatment using cryotherapy, radiotherapy, topical chemotherapy and/or immunotherapy as well as interdisciplinary follow-up care are mandatory for the modern management of patients with conjunctival melanoma.
Collapse
|
25
|
The Role for Sentinel Lymph Node Biopsy in the Management of Conjunctival Melanoma. Int Ophthalmol Clin 2016; 57:87-101. [PMID: 27898616 DOI: 10.1097/iio.0000000000000161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
26
|
Abstract
Herein we present the F-FDG PET/CT findings in conjunctival melanoma as a second primary cancer in a 56-year-old Taiwanese man with a history of small lymphocytic lymphoma/chronic lymphocytic leukemia and nasal cavity carcinoma under remission. The right eye lesion slowly progressed since noted by the patient himself 2 years ago, but he refused biopsy and further treatment including surgery. Either small lymphocytic lymphoma/chronic lymphocytic leukemia or conjunctival melanoma is extremely rare in Asians, left alone in combination with a third malignancy of nasal cavity carcinoma. FDG PET/CT could effectively evaluate malignancies with multiple primary origins.
Collapse
|
27
|
Kao A, Afshar A, Bloomer M, Damato B. Management of Primary Acquired Melanosis, Nevus, and Conjunctival Melanoma. Cancer Control 2016; 23:117-25. [DOI: 10.1177/107327481602300205] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Andrew Kao
- Department of Ophthalmology, University of California, San Francisco, California
| | - Armin Afshar
- Department of Ophthalmology, University of California, San Francisco, California
| | - Michele Bloomer
- Department of Ophthalmology, University of California, San Francisco, California
| | - Bertil Damato
- Department of Ophthalmology, University of California, San Francisco, California
| |
Collapse
|
28
|
Nishiya AT, Massoco CO, Felizzola CR, Perlmann E, Batschinski K, Tedardi MV, Garcia JS, Mendonça PP, Teixeira TF, Zaidan Dagli ML. Comparative Aspects of Canine Melanoma. Vet Sci 2016; 3:vetsci3010007. [PMID: 29056717 PMCID: PMC5644618 DOI: 10.3390/vetsci3010007] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 01/26/2016] [Accepted: 02/01/2016] [Indexed: 12/12/2022] Open
Abstract
Melanomas are malignant neoplasms originating from melanocytes. They occur in most animal species, but the dog is considered the best animal model for the disease. Melanomas in dogs are most frequently found in the buccal cavity, but the skin, eyes, and digits are other common locations for these neoplasms. The aim of this review is to report etiological, epidemiological, pathological, and molecular aspects of melanomas in dogs. Furthermore, the particular biological behaviors of these tumors in the different body locations are shown. Insights into the therapeutic approaches are described. Surgery, chemotherapy, radiotherapy, immunotherapy, and the outcomes after these treatments are presented. New therapeutic perspectives are also depicted. All efforts are geared toward better characterization and control of malignant melanomas in dogs, for the benefit of these companion animals, and also in an attempt to benefit the treatment of human melanomas.
Collapse
Affiliation(s)
- Adriana Tomoko Nishiya
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, CEP 05508-270, São Paulo, Brazil.
| | - Cristina Oliveira Massoco
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, CEP 05508-270, São Paulo, Brazil.
| | - Claudia Ronca Felizzola
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, CEP 05508-270, São Paulo, Brazil.
- Surgical Oncology Rua Antônio Alves Magan, 124, CEP 01251-150, São Paulo, Brazil.
| | - Eduardo Perlmann
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, CEP 05508-270, São Paulo, Brazil.
| | - Karen Batschinski
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, CEP 05508-270, São Paulo, Brazil.
| | - Marcello Vannucci Tedardi
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, CEP 05508-270, São Paulo, Brazil.
| | - Jéssica Soares Garcia
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, CEP 05508-270, São Paulo, Brazil.
| | - Priscila Pedra Mendonça
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, CEP 05508-270, São Paulo, Brazil.
| | - Tarso Felipe Teixeira
- Pathology Veterinary Medicine, FEPI Itajubá University Center, Dr. Antonio Braga Filho Street, 687, Itajubá, 37.501-002 Minas Gerais, Brazil.
| | - Maria Lucia Zaidan Dagli
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, CEP 05508-270, São Paulo, Brazil.
| |
Collapse
|
29
|
Dehghani N, Fouladivanda MR, Ghobadifar MA, Safshekan-Esfahani G, Akbarzadeh A. Nine-Month Follow-up Results of Treatment for Nasolacrimal Duct Obstruction by Probing with Adjunctive Mitomycin C in Adults: A Prospective Randomized Placebo-Controlled Trial. Chonnam Med J 2015; 51:19-25. [PMID: 25914876 PMCID: PMC4406990 DOI: 10.4068/cmj.2015.51.1.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 03/14/2015] [Accepted: 03/16/2015] [Indexed: 12/28/2022] Open
Abstract
The current study aimed to determine the efficacy of probing with adjunctive mitomycin C (MMC) as a treatment for nasolacrimal duct obstruction (NLDO) in adults and to study the association of probing success with demographic and obstruction characteristics. This was a prospective, randomized, double-blind, placebo-controlled trial including 140 patients (each with a unilateral NLDO) scheduled for nasolacrimal probing who were randomly assigned to receive MMC (0.2 mg/ml, 70 patients; group A) or placebo (normal saline, 70 patients; group B). Irrigation was carried out with 0.5 cc of MMC (0.2 mg/mL) in the duct with a nasal pack for 10 minutes in group A. Patients' postprobing epiphora was evaluated at 2 weeks and 1, 3, 6, and 9 months postoperatively. Probing was judged to be a success if there was no or mild watering for at least 9 months after the procedure. There were no significant differences between the two study groups in demographic characteristics or duration of the operation (p=0.062). The overall success rate of probing with MMC was 47/70 (67.1%), which was significantly higher than the success rate of the procedure with placebo (p=0.0027). When the sex of the patients was controlled for by logistic regression, a significant association between the failure rate of probing and increasing age was found in cases and controls (p=0.004 vs. p=0.006, respectively). No significant side effects of probing with MMC were noted after 9 months of follow-up. Administering MMC in a dosage of 0.2 mg/mL during nasolacrimal probing significantly increased the success rate of probing. The failure rate of probing increased with age. A low dose of MMC is cheap, safe, and easily accessible; thus, it is recommended during nasolacrimal probing, especially in patients who refuse dacryocystorhinostomy surgery.
Collapse
Affiliation(s)
- Nader Dehghani
- Department of Ophthalmology, Jahrom University of Medical Sciences, Jahrom, Iran
| | | | | | | | - Armin Akbarzadeh
- Department of Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
30
|
Kopsachilis N, Chatzibougias D, Ziakas N, Detorakis E, Tsatsos M. Chronic red eye due to amelanotic conjuctival melanoma masquerading as pyogenic granuloma. More than meets the eye. Clin Exp Optom 2015; 98:283-5. [PMID: 25619360 DOI: 10.1111/cxo.12251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 09/21/2014] [Accepted: 10/28/2014] [Indexed: 12/17/2022] Open
Affiliation(s)
- Nikolaos Kopsachilis
- Moorfields Eye Hospital, London, United Kingdom.,Modern Eye Centre, Thessaloniki, Greece
| | | | - Nikolaos Ziakas
- 1st Department of Ophthalmology, Aristotle University of Thessaloniki, Greece
| | | | - Michael Tsatsos
- Moorfields Eye Hospital, London, United Kingdom.,Modern Eye Centre, Thessaloniki, Greece
| |
Collapse
|
31
|
Wainstein AJ, Drummond-Lage AP, Kansaon MJ, Bretas GO, Almeida RF, Gloria AL, Figueiredo AR. Sentinel lymph node biopsy for conjunctival malignant melanoma: surgical techniques. Clin Ophthalmol 2015; 9:1-6. [PMID: 25565762 PMCID: PMC4274136 DOI: 10.2147/opth.s71226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this report is to examine the viability and safety of preoperative lymphoscintigraphy and radio guided sentinel lymph node (SLN) biopsy for conjunctival melanoma, and to identify the best technique to perform this procedure. Methods Three patients diagnosed with malignant melanoma of the conjunctiva underwent lymphoscintigraphy and SLN biopsy using a dual technique comprising isosulfan blue dye and technetium Tc 99m sulfur colloid. Each patient was anesthetized and the conjunctival melanoma was excised. SLNs were localized by a gamma probe, identified according to radioactivity and sentinel blue printing, and dissected, along with drainage of the associated lymphatic basins. The SLNs were evaluated by a pathologist using hematoxylin-eosin staining following serial sectioning and immunohistochemistry using a triple melanoma cocktail (S-100, Melan-A, and HMB-45 antigens). Results Two SLNs were stained in the jugular chain during preoperative lymphoscintigraphy in the first patient, two SLNs were identified in the preauricular and submandibular areas in the second patient, and two SLNs were identified in the submandibular and parotid areas in the third patient. All lymph nodes identified by lymphoscintigraphy were dissected and identified at surgery with 100% accuracy in all three patients. All SLNs were histologically and immunohistochemically negative. Patients had good cosmetic and functional results, and maintained their visual acuity and ocular motility. Conclusion Patients with conjunctival melanoma can undergo preoperative lymphoscintigraphy and SLN biopsy safely using radioactive technetium and isosulfan blue dye.
Collapse
Affiliation(s)
- Alberto Ja Wainstein
- Faculty of Medical Sciences of Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil ; Oncad Surgical Oncology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ana P Drummond-Lage
- Faculty of Medical Sciences of Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Milhem Jm Kansaon
- Oncad Surgical Oncology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Gustavo O Bretas
- Oncad Surgical Oncology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Rodrigo F Almeida
- Ophthalmology Department, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ana Lf Gloria
- Ophthalmology Department, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ana Rp Figueiredo
- Ophthalmology Department, Federal University of Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
32
|
Rabinowitz MR, Merton DA, Liu JB, Saxena S, Pluta J, Eisenbrey JR, Baker AL, Rabinowitz MP, Lally S, Cognetti D, Goldberg BB, Pribitkin EA, Curry JM. Contrast-enhanced ultrasound-guided Sentinel lymph node biopsy of the ocular conjunctiva. Laryngoscope 2014; 124:2531-6. [PMID: 24925374 DOI: 10.1002/lary.24789] [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: 11/28/2013] [Revised: 03/27/2014] [Accepted: 05/27/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Sentinel lymph node biopsy (SLNB) has been utilized for cutaneous melanoma and other malignancies arising from the eye and ocular adnexa. Currently, SLNB requires blue dyes and/or radiopharmaceuticals; both of which have significant shortcomings. This study sought to evaluate the feasibility of SLNB with the use of real-time, contrast-enhanced ultrasound (CEUS) as an alternative technique for tumors arising in the conjunctiva. STUDY DESIGN Prospective feasibility study in a porcine model. METHODS Twelve experiments were performed on six non-tumor-bearing Yorkshire swine. An ultrasound contrast agent, Sonazoid (GE Healthcare, Oslo, Norway), (99m) technetium ((99m) Tc), and methylene blue (MB) (Covidien, Mansfield, MA) were injected in the ocular conjunctiva. Sentinel lymph nodes (SLNs) were localized with CEUS and findings were compared to that of MB and (99m) Tc. Fisher exact test was used. RESULTS Contrast-enhanced SLNs were identified within an average of 6.2 minutes from time of injection of Sonazoid. A total of 17 SLNs were identified by at least one of the three techniques. Correlation between Sonazoid and (99m) Tc was 94.1% (16/17 SLNs). Correlation between (99m) Tc and MB was 88.2% (15/17). One SLN that was positive for (99m) Tc but negative for Sonazoid and was considered to be a false positive (1/17); findings were similar for MB (1/17). Differences between the three techniques were not significant (P = .886). CONCLUSIONS CEUS-guided injection of conjunctiva for SLNB is technically feasible and correlates well with standard detection techniques. This technique shows promise for rapid, real-time, intraoperative imaging for SLNB, using a widely available imaging modality and avoiding the need for radiopharmaceuticals. LEVEL OF EVIDENCE NA
Collapse
Affiliation(s)
- Mindy R Rabinowitz
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Nie Y, Du L, Mou Y, Xu Z, Weng L, Du Y, Zhu Y, Hou Y, Wang T. Effect of low frequency magnetic fields on melanoma: tumor inhibition and immune modulation. BMC Cancer 2013; 13:582. [PMID: 24314291 PMCID: PMC4029221 DOI: 10.1186/1471-2407-13-582] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 12/02/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND We previously found that the low frequency magnetic fields (LF-MF) inhibited gastric and lung cancer cell growth. We suppose that exposure to LF-MF may modulate immune function so as to inhibit tumor. We here investigated whether LF-MF can inhibit the proliferation and metastasis of melanoma and influence immune function. METHODS The effect of MF on the proliferation, cell cycle and ultrastracture of B16-F10 in vitro was detected by cell counting Kit-8 assay, flow cytometry, and transmission electron microscopy. Lung metastasis mice were prepared by injection of 2 × 105 B16-F10 melanoma cells into the tail vein in C57BL/6 mice. The mice were then exposed to an LF-MF (0.4 T, 7.5 Hz) for 43 days. Survival rate, tumor markers and the innate and adaptive immune parameters were measured. RESULTS The growth of B16-F10 cells was inhibited after exposure to the LF-MF. The inhibition was related to induction of cell cycle arrest and decomposition of chromatins. Moreover, the LF-MF prolonged the mouse survival rate and inhibited the proliferation of B16-F10 in melanoma metastasis mice model. Furthermore, the LF-MF modulated the immune response via regulation of immune cells and cytokine production. In addition, the number of Treg cells was decreased in mice with the LF-MF exposure, while the numbers of T cells as well as dendritic cells were significantly increased. CONCLUSION LF-MF inhibited the growth and metastasis of melanoma cancer cells and improved immune function of tumor-bearing mice. This suggests that the inhibition may be attributed to modulation of LF-MF on immune function and LF-MF may be a potential therapy for treatment of melanoma.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Yayi Hou
- Immunology and Reproduction Biology Lab, Medical School & State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, 210093 Nanjing, China.
| | | |
Collapse
|
34
|
Miller CV, Cook IS, Jayaramachandran R, Tyers AG. Spontaneous regression of a conjunctival malignant melanoma. Orbit 2013; 33:139-41. [PMID: 24295209 DOI: 10.3109/01676830.2013.851708] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Conjunctival malignant melanoma (MM) is a rare malignancy and accounts for 2% of all ocular malignancies. We describe what we believe to be the first reported case of complete spontaneous regression of a conjunctival malignant melanoma. METHODS A 75-year-old female presented with a large, pigmented lesion in her left lower fornix. Histopathology revealed a mixed cell type MM. The tumour regressed spontaneously. Now, 6 years after she first presented, she remains well and there is no sign of recurrence or metastasis. CONCLUSION Spontaneous regression is not always synonymous with complete cure from the underlying disease but may represent a temporary regression due to host protective mechanisms. In our patient regression and cure were complete.
Collapse
Affiliation(s)
- Christina V Miller
- Department of Ophthalmology, Salisbury District Hospital, NHS Foundation Trust , Salisbury , United Kingdom and
| | | | | | | |
Collapse
|