Last Modified: November 1, 2001
Table of Contents
CancerMail from the National Cancer Institute
UI - 21392454
AU - Krygier G; Lombardo K; Vargas C; Alvez I; Costa R; Ros M; Echenique M; Navarro V; Delgado L; Viola A; Muse A
TI - Familial uveal melanoma: report on three sibling cases.
SO - Br J Ophthalmol 2001 Aug;85(8):1007-8
UI - 21260886
AU - Lakosha H; Pavlin CJ; Simpson R
TI - Rapid response to radiation of choroidal melanoma.
SO - Can J Ophthalmol 2001 Apr;36(3):150-2
AD - Ocular Oncology Service, Princess Margaret Hospital, University of Toronto, Toronto, Ont.
UI - 21378560
AU - Shiraki K; Moriwaki M; Yanagihara N; Kohno T; Miki T
TI - Indocyanine green angiograms of choroidal nevi. comparison between confocal and nonconfocal scanning laser ophthalmoscope and fundus video camera.
SO - Jpn J Ophthalmol 2001 Jul-Aug;45(4):368-74
AD - Department of Ophthalmology, Osaka City University Medical School, Osaka, Japan.
PURPOSE: A fundus video camera and a nonconfocal scanning laser ophthalmoscope (SLO) detect direct light and indirect light, whereas a confocal SLO detects mostly direct light. Differences in confocal and nonconfocal SLO images and fundus video camera images are most likely due to their different optical systems. These differences were examined in indocyanine green (ICG) angiograms of a choroidal nevus. METHODS: A confocal SLO, a nonconfocal SLO, and a high resolution digital fundus video camera were used to obtain ICG angiograms of pigmented choroidal nevi in 4 patients for 30 minutes following dye injection. RESULTS: All the angiograms showed a hypofluorescent region in the nevus until 10-14 minutes after dye injection, except in 1 patient in whom no hypofluorescent region was seen in an early confocal-SLO angiogram. From 20 minutes to 30 minutes postinjection, the hypofluorescent regions were still visible in all fundus video camera angiograms and nonconfocal SLO angiograms but not in confocal SLO angiograms. CONCLUSIONS: Early angiograms taken with the three angiography systems showed a similar appearance of the choroidal nevus. However, late ICG angiograms with a confocal SLO showed different images from those taken with a nonconfocal SLO or a fundus video camera. It is suggested that the angiography system and the aperture size of an SLO should be selected according to the aspect of the pigmented choroidal nevus that is of interest in late-phase ICG angiography.
UI - 21283567
AU - Meyer D; Yoser S; Xu S; Westmoreland D
TI - Amelanotic malignant choroidal melanoma in a 10-year-old girl.
SO - J Pediatr Ophthalmol Strabismus 2000 Nov-Dec;37(6):365-8
AD - Vitreoretinal Foundation, Memphis, Tenn 38120, USA.
UI - 21353983
AU - Desjardins L; Lumbroso L; Levy C; Plancher C; Asselain B
TI - [Risk factors for the degeneration of the choroid naevi: a retrospective study of 135 cases]
SO - J Fr Ophtalmol 2001 Jun;24(6):610-6
AD - Service d'Ophtalmologie, Institut Curie, 26,rue d'Ulm, 75005 Paris, France.
INTRODUCTION: We have carried out a retrospective study of 135 patients followed at Curie Institute for choroidal naevus between March 1983 and June 1997. PATIENTS AND METHODS: 54 patients presented naevi considered as benign and 81 patients presented suspicious choroidal naevi (with at least one of the following findings: visual symptoms; serious detachment of the retina; orange pigment; thickness greater than 2mm or a diameter greater than 7mm). These suspicious naevi were followed more carefully. The median follow-up was 49 months. The median diameter of the lesions was 6mm and the median thickness was 1.5mm. We studied the age of the patients, clinical symptoms, the presence or absence of orange pigment, drusen and serious detachment, and the angiographic and echographic findings. RESULTS: 3 patients died of unrelated cause; 7 patients were lost to follow-up; 30 patients presented documented growth; 4 of them belonged to the group considered as benign and 26 to the group considered as suspicious, with a significant difference between the groups. The lesions that grew were treated by proton beam or I125 patches. The risk factors for growth that were statistically significant were the presence of visual symptoms, pin points, orange pigment, serous detachment and thickness greater than 2mm. With drusen, the risk for growth was significantly less. DISCUSSION: These results are very similar to those published in the literature concerning risk factors for growth of choroidal nevi. The absence of metastatic spread in patients whose nevi have grown show that it is possible to monitor choroidal naevi if there is a doubt as to the malignant or benign nature of the lesion. CONCLUSION: It is important to determine if a choroidal naevus is suspicious or benign and to propose closer follow-up for suspicious lesions.
UI - 21420944
AU - Finger PT
TI - Plaque radiation therapy for malignant melanoma of the iris and ciliary body.
SO - Am J Ophthalmol 2001 Sep;132(3):328-35
AD - The New York Eye Cancer Center, 115 East 61st Street, New York, NY 10021, USA. email@example.com
PURPOSE: To report on plaque radiation therapy for malignant melanomas involving the iris and ciliary body. METHODS: Twenty-two eyes (22 patients) with anterior uveal melanomas were treated with (103)Pd ophthalmic plaque radiation therapy. Transillumination and ultrasonography were used to evaluate ciliary body involvement and posterior iris extension. Plaques were placed onto the cornea to treat the anterior tumor margins. The targeted-zone included the tumor and a 2 to 3 mm tumor-free margin. After plaque removal, patients were examined at 1 day, 7 days, 4 weeks, and then every 3 to 6 months thereafter. Systemic evaluations for possible metastatic disease were performed every 6 months. RESULTS: After plaque radiation therapy, the melanomas decreased in thickness (mean 47%) in all 22 eyes, and no secondary enucleation was performed. One patient died of metastatic melanoma 5 years after radiation therapy. Despite anterior plaque placement that covered portions of the cornea, no epiphora, eyelash loss, or visually significant corneal opacities were noted. Whereas 15 of 21 phakic eyes (71%) developed secondary cataract, no eyes developed ischemic or neovascular radiation maculopathy. Four eyes were noted to have glaucoma before treatment, and two developed it after irradiation. Twenty of 22 eyes (91%) were within 2 lines of their pretreatment visual acuity. After radiation, the mean +/- SD follow-up was 56 +/- 34.4 months (range, 9 to 117 months). CONCLUSIONS: Plaque radiotherapy of melanomas involving the iris and ciliary body resulted in excellent local control with preservation of vision. Although there was high incidence of secondary cataracts, (103)Pd plaque radiation therapy resulted in no visually significant corneal opacity or radiation retinopathy.
UI - 21420945
AU - Demirci H; Shields CL; Shields JA; Eagle RC Jr; Honavar S
TI - Ring melanoma of the anterior chamber angle: a report of fourteen cases.
SO - Am J Ophthalmol 2001 Sep;132(3):336-42
AD - Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 900 Walnut St., Philadelphia, PA 19107, USA.
PURPOSE: Ring melanoma of the anterior chamber angle is a rare variant of uveal melanoma that manifests as circumferential, flat tumor growth predominantly confined to the trabecular meshwork and other anterior chamber angle structures. We report the clinical and histopathological features, management, and prognosis of ring melanoma of anterior chamber angle. METHODS: A retrospective review of clinical features, management, histopathologic features, and prognosis was performed. Of 8800 patients with uveal melanoma examined on the Oncology Service at Wills Eye Hospital over a 25-year period, only 14 patients (0.2%; 14 eyes) were classified clinically as ring melanoma of the anterior chamber angle. In no case was there appreciable involvement of the iris or ciliary body on clinical examination. RESULTS: The patients were followed elsewhere for a mean of 8 months before intraocular malignancy was suspected. Upon referral to the Oncology Service, the intraocular pressure was greater than 22 mm Hg in the affected eye in all patients (mean, 36 mm Hg; median, 35 mm Hg; range, 24 to 48 mm Hg), and all patients were using at least two glaucoma medications. The melanoma infiltrated the anterior chamber angle for a mean of 10 clock hours (range, 8 to 12 clock hours). Tumor management consisted of enucleation in 13 cases and plaque radiotherapy in one case. Histopathologic examination revealed epithelioid cell type melanoma in one case, mixed cell type in nine, and spindle cell type in four. Of the 13 patients who underwent enucleation, tumor cells were found within the Schlemm canal in all cases. Five cases displayed invasion of the intrascleral canals, and three showed episcleral invasion. With the exception of two recent cases, 12 patients were followed for a mean of 64 months (median, 47 months; range, 23 to 225 months). Distant metastasis to the liver was detected in three of 12 patients (25%) after a mean follow-up of 78 months (median, 70; range, 37 to 128 months). CONCLUSIONS: Ring melanoma of the trabecular meshwork and angle structures is a rare variant of diffuse uveal melanoma. It often masquerades as unilateral glaucoma and can be difficult to recognize clinically unless careful comparative gonioscopy is performed. Despite the relatively small tumor volume, life prognosis is guarded with distant metastasis in 25% at mean 6 years follow-up.
UI - 21420963
AU - Naseripour M; Shields CL; Shields JA; Guyer DR
TI - Pseudohypopyon of orange pigment overlying a stable choroidal nevus.
SO - Am J Ophthalmol 2001 Sep;132(3):416-7
AD - Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 900 Walnut St., Philadelphia, PA 19107, USA.
PURPOSE: To report an unusual case of orange pigment pseudohypopyon overlying a choroidal nevus. METHODS: Observational case report. A 45-year-old man presented with best-corrected visual acuity of 20/25 and metamorphopsia in the right eye secondary to localized subfoveal fluid. The detachment displayed a peculiar appearance of layered orange pigment, like a pseudohypopyon in its inferior aspect. Closer inspection revealed an underlying choroidal nevus and no choroidal neovascular membrane. RESULTS: After 31 months of follow-up without treatment, the size of the nevus and visual acuity remained stable and metamorphopsia continued to resolve as the orange pigment and the subretinal fluid disappeared completely. CONCLUSION: An otherwise stable choroidal nevus can display overlying clumps of orange pigment and rarely massive accumulation of orange pigment in the form of a pseudohypopyon. Orange pigment pseudohypopyon can spontaneously resolve with preserved visual acuity.
UI - 21420964
AU - Krohn J; Seland JH; Monge OR; Rekstad BL
TI - Transillumination for accurate placement of radioactive plaques in brachytherapy of choroidal melanoma.
SO - Am J Ophthalmol 2001 Sep;132(3):418-9
AD - Department of Ophthalmology, Haukeland Hospital, University of Bergen, N-5021 Bergen, Norway. firstname.lastname@example.org
PURPOSE: To present a technique for accurate plaque placement in episcleral brachytherapy of choroidal melanoma. METHODS: The tumor margins are marked on the scleral surface, and a dummy plaque is temporarily sutured to the globe. A fiber optic light pipe is then wedged into the space between the sclera and the plaque. Because of the reflecting inner surface of the plaque, the perimeter of the plaque can easily be observed during indirect ophthalmoscopy as a circle of light surrounding the tumor. By this method, it is possible to determine the exact position of the entire plaque in relation to the tumor and make the necessary adjustments. When the correct position is found, the dummy plaque is replaced by a radioactive plaque. RESULTS: Since 1993, we have routinely used this procedure in episcleral brachytherapy. CONCLUSION: This modified transillumination technique facilitates a correct positioning of episcleral plaques.
UI - 21361589
AU - Singh AD; Shields CL; Shields JA
TI - Prognostic factors in uveal melanoma.
SO - Melanoma Res 2001 Jun;11(3):255-63
AD - Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 900 Walnut Street, Philadelphia, PA 19107, USA.
Uveal melanoma is the most common primary intraocular malignant tumour, with an annual incidence of approximately six cases per million per year. Approximately 40% of patients with posterior uveal melanoma develop metastatic melanoma to the liver within 10 years after initial diagnosis. Despite high accuracy of diagnosis and availability of various methods of treatment; the mortality due to uveal melanoma has remained unchanged. The prognosis in uveal melanoma depends on clinical, histopathological and cytological factors. Clinical factors that relate to prognosis include location, size, and configuration of the tumour. Uveal melanoma can arise in the iris, the ciliary body or the choroid. Iris melanomas have the best prognosis and ciliary body melanomas have the worst prognosis. Based on retrospective studies, the mortality rates for uveal melanoma for comparable sized tumours treated by enucleation or other globe conserving methods such as radiotherapy appear to be similar. Histopathological factors such as cell type, mitotic activity, microcirculation architecture, tumour-infiltrating lymphocytes and the presence of extrascleral extension are also significant predictors of survival. More recently, cytological factors such as cell proliferation, cytogenic, and molecular genetic prognostic markers have been identified with the hope of detecting high risk cases for adjuvant systemic immune therapy or chemotherapy. At present, the role of these therapeutic methods is not clearly established.
UI - 21361590
AU - Baker JK; Elshaw SR; Mathewman GE; Nichols CE; Murray AK; Parsons MA; Rennie IG; Sisley K
TI - Expression of integrins, degradative enzymes and their inhibitors in uveal melanoma: differences between in vitro and in vivo expression.
SO - Melanoma Res 2001 Jun;11(3):265-73
AD - Institute for Cancer Studies, University of Sheffield, Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
Posterior uveal melanoma is the most common intraocular malignancy in adults. Metastasis occurs in approximately 40% of all cases and spread is primarily to the liver. Once secondary hepatic disease has developed the prognosis is poor. Metastasis involves a series of adhesion and de-adhesion events, coupled with regulated tissue degradation to facilitate tumour cell invasion and spread to both local and distant sites. These processes are assisted by the expression of integrins and degradative enzymes by both tumour and host cells. Using a series of 10 uveal melanomas, we investigated the expression of a panel of integrins, degradative enzymes and their inhibitors that have been shown to be associated with metastasis. In addition, we undertook to establish if there might be differential expression in response to growth under artificial conditions. All the tumours expressed matrix metalloproteinases (MMP)-2 and-9, tissue inhibitor of metalloproteases (TIMP)-2, urokinase plasminogen activator (u-PA), plasminogen activator inhibitor (PAI)-1 and PAI-2. Differences in the expression of the integrins alpha1beta1, alpha2beta1 and alpha6beta1 were observed; in particular, these differences appeared to relate to expression as a consequence of growth in culture. In summary, uveal melanoma cells express both degradative enzymes and their respective inhibitors, which are important in metastasis. It would appear that differential expression of integrins is present, probably as a response to in vitro stimulation.
UI - 21361591
AU - Cresswell AC; Sisley K; Laws D; Parsons MA; Rennie IG; Murray AK
TI - Reduced expression of TAP-1 and TAP-2 in posterior uveal melanoma is associated with progression to metastatic disease.
SO - Melanoma Res 2001 Jun;11(3):275-81
AD - Institute of Cancer Studies, G Floor, Medical School, Beech Hill Road, Sheffield, UK.
In order to determine the effects of the loss or reduced expression of molecules associated with antigen presentation (transporter associated with antigen presentation [TAP]-1, TAP-2, low molecular weight protein [LMP]-2 and LMP-7), we examined the expression of these molecules in primary uveal melanoma lesions. Paraffin-embedded sections from 29 primary uveal melanoma lesions were analysed for expression of TAP-1, TAP-2, LMP-2 and LMP-7 using specific primary antibodies followed by a three-stage immunoperoxidase technique. Microscopic examination was undertaken to determine differences in expression of these molecules on the tumour and the surrounding stroma. Overall, 72% (21 out of 29) of the tumours showed some loss or reduced expression of TAP-1, TAP-2, LMP-2 and/or LMP-7. Statistical analysis of these results showed that progression to metastatic disease was strongly associated with reduced expression of TAP-1 (P < 0.05) and TAP-2 (P < 0.01), taking patient age, tumour site and histology into account. We conclude that the reduced expression of molecules important in eliciting an immune response, such as TAP-1 and TAP-2, may facilitate the metastatic spread of uveal melanoma lesions and may have important implications for prospective immunotherapy.
UI - 21404704
AU - Barakova D; Redinova M
TI - [Ultrasonography of choroidal melanoma]
SO - Cesk Slov Oftalmol 2001 Jul;57(4):237-43
AD - Ocni klinika 3. LF UK a FN KV, v Praze.
The authors discuss the use of standardized echography in the diagnosis of melanoma of the choroid. They mention the investigated acoustic criteria in images B and A (shape, size, limits, site, structure, reflectivity, weakening of the ultrasonic signal, vascularization, mobility, consistence) and their importance for more detailed identification of the tumour. Investigation of the acoustic properties of choroid melanoma and assessment of acoustic criteria for echographic assessment of choroid was based on echographic examination of a total of 109 bulbi where melanoma was confirmed also by histological examination.
UI - 21407960
AU - Egger E; Schalenbourg A; Zografos L; Bercher L; Boehringer T; Chamot L; Goitein G
TI - Maximizing local tumor control and survival after proton beam radiotherapy of uveal melanoma.
SO - Int J Radiat Oncol Biol Phys 2001 Sep 1;51(1):138-47
AD - Division of Radiation Medicine, Paul Scherrer Institute, Villigen, Switzerland. email@example.com
PURPOSE: This study reports local tumor control and survival after proton beam radiotherapy (PBRT) of uveal melanoma. It identifies the risk factors for local tumor-control failure and for ocular tumor-related death. It presents the improvements implemented to increase the rate of local tumor control, and compares the survival rate of patients with locally controlled tumors to those of patients who had to receive a second treatment. PATIENTS AND METHODS: We have treated 2,435 uveal melanomas with PBRT between March 1984 and December 1998. Data were analyzed as of September 1999. Patients' age ranged from 9 to 89 years; there were 1,188 men and 1,247 women. The largest tumor diameter ranged from 4 to 26 mm, and tumor thickness from 0.9 to 15.6 mm. Median follow-up time was 40 months. RESULTS: Local tumor control probability at 5 years was improved from 90.6 +/- 1.7% for patients treated before 1988, to 96.3 +/- 0.6% for patients treated between 1989 and 1993, and became 98.9 +/- 0.6% for patients treated after 1993. Among 2,435 treated patients, 73 (3%) had to receive a second treatment because of tumor regrowth. Cause-specific survival at 10 years was calculated to 72.6 +/- 1.9% for patients with controlled tumors compared to 47.5 +/- 6.5% for those with recurrent tumors. CONCLUSION: Reduced safety margins, large ciliary body tumors, eyelids within the treatment field, inadequate positioning of tantalum clips, and male gender were identified to be the main factors impairing local tumor control. The improvement of local tumor control rate after 1993 is attributed to changes implemented in the treatment procedure. Our data strongly support that the rate of death by metastases is influenced by local tumor control failure: improvement of the local tumor control rate results in a better survival rate.
UI - 21414084
AU - Anastassiou G; Coupland SE; Stang A; Boeloeni R; Schilling H; Bornfeld N
TI - Expression of Fas and Fas ligand in uveal melanoma: biological implication and prognostic value.
SO - J Pathol 2001 Aug;194(4):466-72
AD - Department of Ophthalmology, University Hospital, University of Essen, Hufelandstrasse 55, D-45122 Essen, Germany. firstname.lastname@example.org
The interaction between Fas and Fas ligand is one possible immune escape mechanism used by tumour cells. In the present study, melanoma tissue from 103 patients who underwent enucleation for malignant uveal melanoma (iris melanomas excluded) was stained by immunohistochemistry with monoclonal antibodies specific for Fas, Fas ligand, CD3, CD8, and CD68. Histological and clinical data for these tumours were assessed. Both Fas and Fas ligand were detected in uveal melanomas. Cells of the monocyte/macrophage lineage rather than T-cells were the predominant group of tumour-infiltrating cells. The metastasis-free 5-year survival rates in the univariate analyses were considerably lower in patients with tumours that lacked Fas ligand expression (< 35% of the tumour cells), in the presence of more than 50 CD8-positive cells in 20 high-power fields and in the presence of more than 100 CD3-positive cells in 20 high-power fields. Fas and Fas ligand expression was associated with scleral infiltration. After adjustment for scleral infiltration, the predictive value of both Fas and Fas ligand expression was markedly decreased. In addition, the CD3- and CD8-positive cell count was positively associated with the histological cell type. Cox proportional hazards models showed that the presence of CD3- and CD8-positive cells was not an independent prognostic factor after adjusting for histological cell type. This preliminary observation deserves further investigation, which may shed more light on the immune escape mechanisms of this tumour and thus enable novel therapeutic strategies. The clinical relevance of this observation is limited, as more predictive parameters have been described for uveal melanoma. Copyright 2001 John Wiley & Sons, Ltd.
UI - 21419306
AU - Ericsson C; Seregard S; Bartolazzi A; Levitskaya E; Ferrone S; Kiessling R; Larsson O
TI - Association of HLA class I and class II antigen expression and mortality in uveal melanoma.
SO - Invest Ophthalmol Vis Sci 2001 Sep;42(10):2153-6
AD - St. Erik's Eye Hospital, Stockholm, Sweden.
PURPOSE: Malignant transformation of cells is frequently associated with abnormalities in human leukocyte antigen (HLA) expression. These abnormalities may play a role in the clinical course of the disease, because HLA antigens mediate interactions of tumor cells with T cells and NK cells. Uveal melanoma is a highly malignant tumor of the eye and is characterized by a hematogenic spread to the liver. Little is known about the role of HLA expression in progression of this malignant disease. METHODS: In the present study HLA class I antigen, beta(2)-microglobulin (beta(2)-m), and HLA class II antigen expression was analyzed in primary uveal melanoma lesions by immunoperoxidase staining with monoclonal antibodies of 65 archival clinical samples. The results were correlated with the clinical course of the disease. RESULTS: HLA class I antigen expression and beta(2)-m expression were downregulated in 40 and 35 lesions, respectively. HLA class II antigens were expressed in 30 lesions. Patients with high HLA class I, including beta(2)-m, and HLA class II antigen expression in their primary melanoma lesions had a significantly decreased survival (P = 0.009, P < 0.001, and P = 0.006, respectively). CONCLUSIONS: The findings argue against a major role of cytotoxic T-lymphocyte (CTL)-mediated control of tumor growth in the clinical course of uveal melanoma and are compatible with a potential role of NK-cell-mediated control of hematogenic metastatic spread.
UI - 21430666
AU - Romero JM; Finger PT; Rosen RB; Iezzi R
TI - Three-dimensional ultrasound for the measurement of choroidal melanomas.
SO - Arch Ophthalmol 2001 Sep;119(9):1275-82
AD - New York Eye and Ear Infirmiry, New York, NY, USA.
OBJECTIVE: To evaluate the reliability of 3-dimensional ultrasound (3D-US) for the measurement of choroidal melanomas. DESIGN: Retrospective case series. PARTICIPANTS: Forty-two consecutive cases of choroidal melanoma imaged with 3D-US. METHODS: Tumor measurements obtained with ophthalmoscopy, transillumination, standard ultrasound techniques, 3D-US, and pathological studies. Tumor diameters, heights, and volumes were compared. Our 3D-US tumor measurement techniques were tested for intraobserver and interscan reproducibility. RESULTS: Fifty 3D-US images were studied. The 3D-US tumor measurements were found to be reproducible (height coefficient of variation [CV] < or = 3%; diameter CV < or = 9.7%; volume CV < or = 13.2%). There was significant correlation with the usual methods of tumor measurement (diameter r = 0.76; height r > or = 0.98). Significant differences were found between measurements at pathological examination, as compared with both 2-dimensional and 3D-US height measurements (range, 0.73-0.83 mm). This finding was thought to be due to specimen shrinkage. Three-dimensional ultrasound was found to be at least as reproducible as clinical examination and standard ultrasound techniques used for measurement of diameter and height of choroidal melanomas. It was our impression that the 3D-US volume measurements accounted for the geometry of the tumor better than volume estimates calculated from basal area and tumor height. CONCLUSIONS: Three-dimensional ultrasound measurements of choroidal melanoma were reproducible, correlated well with other tumor measurement techniques, and can be used for measurement of choroidal melanomas.