Jasmine H Francis1, Duncan Berry2, David H Abramson3, Christopher A Barker4, Chris Bergstrom5, Hakan Demirci6, Michael Engelbert7, Hans Grossniklaus2, Baker Hubbard2, Codrin E Iacob8, Korey Jaben3, Madhavi Kurli9, Michael A Postow10, Jedd D Wolchok10, Ivana K Kim11, Jill R Wells2. 1. Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical Center, New York, New York. Electronic address: francij1@mskcc.org. 2. Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia. 3. Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical Center, New York, New York. 4. Weill Cornell Medical Center, New York, New York; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York. 5. Retina Consultants of Carolina, Greenville, South Carolina. 6. Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan. 7. Vitreous Retina Macula Consultant of New York, New York, New York; Department of Ophthalmology, New York University Langone Health, New York, New York. 8. Department of Pathology, The New York Eye and Ear Infirmary of Mount Sinai, New York, New York. 9. Advanced Retina & Eye Cancer Center, Phoenix, Arizona. 10. Weill Cornell Medical Center, New York, New York; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. 11. Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
Abstract
PURPOSE: Cutaneous melanoma metastatic to the vitreous is very rare. This study investigated the clinical findings, treatment, and outcome of patients with metastatic cutaneous melanoma to the vitreous. Most patients received checkpoint inhibition for the treatment of systemic disease, and the significance of this was explored. DESIGN: Multicenter, retrospective cohort study. PARTICIPANTS: Fourteen eyes of 11 patients with metastatic cutaneous melanoma to the vitreous. METHODS: Clinical records, including fundus photography and ultrasound results, were reviewed retrospectively, and relevant data were recorded for each patient eye. MAIN OUTCOME MEASURES: Clinical features at presentation, ophthalmic and systemic treatments, and outcomes. RESULTS: The median age at presentation of ophthalmic disease was 66 years (range, 23-88 years), and the median follow-up from diagnosis of ophthalmic disease was 23 months. Ten of 11 patients were treated with immune checkpoint inhibition at some point in the treatment course. The median time from starting immunotherapy to ocular symptoms was 17 months (range, 4.5-38 months). Half of eyes demonstrated amelanotic vitreous debris. Five eyes demonstrated elevated intraocular pressure, and 4 eyes demonstrated a retinal detachment. Six patients showed metastatic disease in the central nervous system. Ophthalmic treatment included external beam radiation (30-40 Gy) in 6 eyes, intravitreous melphalan (10-20 μg) in 4 eyes, enucleation of 1 eye, and local observation while receiving systemic treatment in 2 eyes. Three eyes received intravitreous bevacizumab for neovascularization. The final Snellen visual acuity ranged from 20/20 to no light perception. CONCLUSIONS: The differential diagnosis of vitreous debris in the context of metastatic cutaneous melanoma includes intravitreal metastasis, and this seems to be particularly apparent during this era of treatment with checkpoint inhibition. External beam radiation, intravitreous melphalan, and systemic checkpoint inhibition can be used in the treatment of ophthalmic disease. Neovascular glaucoma and retinal detachments may occur, and most eyes show poor visual potential. Approximately one quarter of patients demonstrated ocular disease that preceded central nervous system metastasis. Patients with visual symptoms or vitreous debris in the context of metastatic cutaneous melanoma would benefit from evaluation by an ophthalmic oncologist.
PURPOSE:Cutaneous melanoma metastatic to the vitreous is very rare. This study investigated the clinical findings, treatment, and outcome of patients with metastatic cutaneous melanoma to the vitreous. Most patients received checkpoint inhibition for the treatment of systemic disease, and the significance of this was explored. DESIGN: Multicenter, retrospective cohort study. PARTICIPANTS: Fourteen eyes of 11 patients with metastatic cutaneous melanoma to the vitreous. METHODS: Clinical records, including fundus photography and ultrasound results, were reviewed retrospectively, and relevant data were recorded for each patient eye. MAIN OUTCOME MEASURES: Clinical features at presentation, ophthalmic and systemic treatments, and outcomes. RESULTS: The median age at presentation of ophthalmic disease was 66 years (range, 23-88 years), and the median follow-up from diagnosis of ophthalmic disease was 23 months. Ten of 11 patients were treated with immune checkpoint inhibition at some point in the treatment course. The median time from starting immunotherapy to ocular symptoms was 17 months (range, 4.5-38 months). Half of eyes demonstrated amelanotic vitreous debris. Five eyes demonstrated elevated intraocular pressure, and 4 eyes demonstrated a retinal detachment. Six patients showed metastatic disease in the central nervous system. Ophthalmic treatment included external beam radiation (30-40 Gy) in 6 eyes, intravitreous melphalan (10-20 μg) in 4 eyes, enucleation of 1 eye, and local observation while receiving systemic treatment in 2 eyes. Three eyes received intravitreous bevacizumab for neovascularization. The final Snellen visual acuity ranged from 20/20 to no light perception. CONCLUSIONS: The differential diagnosis of vitreous debris in the context of metastatic cutaneous melanoma includes intravitreal metastasis, and this seems to be particularly apparent during this era of treatment with checkpoint inhibition. External beam radiation, intravitreous melphalan, and systemic checkpoint inhibition can be used in the treatment of ophthalmic disease. Neovascular glaucoma and retinal detachments may occur, and most eyes show poor visual potential. Approximately one quarter of patients demonstrated ocular disease that preceded central nervous system metastasis. Patients with visual symptoms or vitreous debris in the context of metastatic cutaneous melanoma would benefit from evaluation by an ophthalmic oncologist.
Authors: Jasmine H Francis; Scott E Brodie; Brian Marr; Emily C Zabor; Ijah Mondesire-Crump; David H Abramson Journal: Ophthalmology Date: 2017-01-12 Impact factor: 12.079
Authors: Amaya B Fernandez-Diaz; Adrian García-Medina; Blanca Ferrer-Guillen; Alfonso Berrocal Journal: Melanoma Res Date: 2019-06 Impact factor: 3.599
Authors: J Bryan Iorgulescu; Maya Harary; Cheryl K Zogg; Keith L Ligon; David A Reardon; F Stephen Hodi; Ayal A Aizer; Timothy R Smith Journal: Cancer Immunol Res Date: 2018-07-12 Impact factor: 11.151
Authors: Jedd D Wolchok; Vanna Chiarion-Sileni; Rene Gonzalez; Piotr Rutkowski; Jean-Jacques Grob; C Lance Cowey; Christopher D Lao; John Wagstaff; Dirk Schadendorf; Pier F Ferrucci; Michael Smylie; Reinhard Dummer; Andrew Hill; David Hogg; John Haanen; Matteo S Carlino; Oliver Bechter; Michele Maio; Ivan Marquez-Rodas; Massimo Guidoboni; Grant McArthur; Celeste Lebbé; Paolo A Ascierto; Georgina V Long; Jonathan Cebon; Jeffrey Sosman; Michael A Postow; Margaret K Callahan; Dana Walker; Linda Rollin; Rafia Bhore; F Stephen Hodi; James Larkin Journal: N Engl J Med Date: 2017-09-11 Impact factor: 91.245
Authors: David I T Sia; Caroline Thaung; Ciara O'Hanlon-Brown; Victoria M L Cohen; Mandeep S Sagoo Journal: Melanoma Res Date: 2018-08 Impact factor: 3.599
Authors: Carol L Shields; Nicholas E Kalafatis; Maikel Gad; Mrittika Sen; Andrea Laiton; Ana Maria Velasco Silva; Kushal Agrawal; Sara E Lally; Jerry A Shields Journal: Eye (Lond) Date: 2022-03-19 Impact factor: 3.775
Authors: Jasmine H Francis; Julia Canestraro; David H Abramson; Christopher A Barker; Alexander N Shoushtari Journal: Am J Ophthalmol Case Rep Date: 2022-04-09