Ocular melanoma

A 60-year-old smoker was treated with interferon alfa (100 MU/week for 2 months and 9 MU/week for 15 weeks) for cutaneous melanoma. Ocular examination was normal before treatment, but he developed acute loss of peripheral vision in his left eye after 23 weeks. Examination was consistent with anterior ischemic optic neuropathy, and there was optic disc edema, a pupillary defect, and circular visual field constriction in the left eye. There was renal artery constriction in both eyes. Despite treatment with aspirin, high-dose dexamethasone, heparin, and finally withdrawal of interferon alfa, loss of visual function progressed and affected both eyes. Ciclosporin was started, but he was considered to have irreversible loss of visual function. 

Ocular damage, skin cancer (including melanoma) OBRA regulated in U.S. Long Term Care... 

Uveal Melanoma. Charged particle beams and, in particular, protons are ideal for treating intraocular lesions since they can be made to deposit their absorbed dose in the target volume, while significantly limiting the irradiation of the noninvolved ocular and orbital structures (Fig. 16). 

This report shows that interferon alfa can be a potent precipitator of extremely severe ocular disorders and also argues for careful ocular surveillance in patients receiving adjuvant interferon alfa for high-risk resected melanoma. 

General Population Exposures. An increased annual occurrence of ocular melanoma was discerned in Ohio residents during 1967-1977 (1.09 cases/100,000 persons/year versus 0.6 in other reports), with no... 

Davidorf FH, Knupp JA. 1979. Epidemiology of ocular melanoma Incidence and geographic relationship in Ohio (1967-1977). Ohio State Med J 75 561-564. 

Van Ginkel PR, Gee RL, Walker TM, et al. lire identification and differential expression of calcirrm-binding proteins associated with ocular melanoma. Biochim Biophys Acta. 1998 1448 290-297. 

Nicotra MR, Nistico P, Mangoni A, et al. Melan-A/MART-1 antigen expression in cutaneous and ocular melanomas. J Immunother. 1997 20 466-469. 

Manual of Procedures, Chap. 12, Collaborative Ocular Melanoma Study Coordination Center, Baltimore, 1992. 

D.J. Blom, H.J. Schuitmaker, I. de Waard-Siebinga, T.M. Dubbelman, M.J. Jager (1997). Decreased expression of HLA class I on ocular melanoma cells following in vitro photodynamic therapy. Cancer Lett., 112, 239-243. 

Vaccines for ocular melanoma are undergoing phase III testing in both the USA and Europe. These studies are particularly designed to see whether liver metastases of this ocular cancer can be prevented. Both compounds contain melanoma differentiation peptides and adjuvants. 

Ocular melanoma can arise from various structures within the eye and accounts for 70% of all primary malignancies of the eye. At the time of diagnosis, metastases are uncommon but appear in 19%-35% of patients within 5 years. Unlike cutaneous melanoma, metastases from uveal melanoma is most commonly found within the liver in more than 50% of patients (Kath et al. 1993), followed by lungs, bone, and... 

Leyvraz S et al. (1997) Treatment of ocular melanoma metastatic to the liver by hepatic arterial chemotherapy. J Clin Oncol 15 2589-2595... 

Sullivan K et al. (2001) Survival of patients with hepatic metastases from ocular melanoma following chemoembolization with ethiodol soluble chemotherapy. 26th Annual scientific meeting of the Society of Cardiovascular and Interventional Radiology, San Antonio, Texas Sun S, Lang EV (1998) Bone metastases from renal cell carcinoma preoperative embolization. J Vase Intervent Radiol 9 263-269... 

A response to chemoembolization can be expected in liver tumors, such as HCC, metastases from colorectal tumors, metastases from neuroendocrine tumors, metastases from ocular melanoma, and gastrointestinal sarcomas (Gates et al. 1999 VoGL et al. 2000, 2003 Zangos et al. 2001 Kress et al. 2003 Roche et al. 2003). Other tumor types showed only a little response after chemoembolization. In every patient the advantages of treatment should be balanced against possible risks. 

In melanoma the liver is the most common site for systemic metastases. TACE can be performed in patients with liver metastases to improve the survival. Agarwala et al. observed that TACE produces a modest response rate in patients with ocular melanoma and liver metastases (Agarwala et al. 2004). Chemoembolization using l,3-bis(2-chloroethyl)-l-nitrosourea (BCNU) dissolved in ethiodized oil is a useful palliative treatment for the control of hepatic metastases in uveal melanoma patients. However, progression in extrahepatic sites after stabilization of hepatic metastases requires further improvement in the therapeutic approach to this disease (Patel et al. 2005). 

Agarwala SS, Panikkar R, Kirkwood JM (2004) Phase I/II randomized trial of intrahepatic arterial infusion chemotherapy with cisplatin and chemoembolization with cisplatin and polyvinyl sponge in patients with ocular melanoma metastatic to the liver. Melanoma Res 14 217-222... 

Martinelli DJ, Wadler S, Bakal CW, Cynamon J, Rozenblit A, Haynes H, Kaleya R, Wiernik PH (1994) Utility of embolization or chemoembolization as second-line treatment in patients with advanced or recurrent colorectal carcinoma [see comments]. Cancer 74 1706-1712 Mavligit GM, Charnsangavej C, Carrasco CH, Patt YZ, Benjamin RS, Wallace S (1988) Regression of ocular melanoma metastatic to the liver after hepatic arterial chemoembolization with cisplatin and polyvinyl sponge. J Am Med Assoca 260 974-976... 

Feldman ED et al. (2004) Regional treatment options for patients with ocular melanoma metastatic to the hver. Ann Surg Oncol 11 290-297... 

The liver is the most common site of metastatic disease. Hepatic metastases most commonly occur from colorectal cancer and, less frequently, from neuroendocrine tumours, gastrointestinal sarcoma, ocular melanoma, and others. Complete evaluation of the extent of metastatic disease, both within and outside the liver, is important before considering treatment options. 

Treatment concepts for liver metastases are determined by the biology of tbe disease and, in the case of the disease being confined to the liver, by the number and topographic location of the metastases. Colorectal liver metastases are the most frequent indication for the use of regional treatment concepts for the liver. Liver metastases from other primary tumors, such as the breast, neuroendocrine tumors (carcinoids), ocular melanoma, renal cell cancer, and sarcoma, have also been removed by treatment approaches confined to the liver with curative intent. 

Additional indications for resection/ablation are isolated liver metastases of hreast cancer, renal cell cancer and Wilms tumors, sarcoma, melanoma (mostly of ocular origin), and, rarely, other G1 cancers neuroendocrine liver metastases are a frequent indication for curative resection or cytoreductive surgery in combination with the primary tumor location and extrahepatic metastases. 

---