Uveal melanoma associated with myotonic dystrophy a report of 6 cases

Lauren A. Dalvin, Carol L. Shields, Jose S Pulido, Kareem Sioufi, Victoria Cohen, Jerry A. Shields

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

IMPORTANCE Patients with myotonic dystrophy (MD) have an increased risk of malignancy including uveal melanoma. This case series further explores the association between these 2 diseases. OBJECTIVE To describe a cohort of patients with uveal melanoma associated with MD, including a case of iris melanoma, and MD-associated uveal melanoma in relatives. DESIGN, SETTING, AND PARTICIPANTS Retrospective case series at 3 tertiary referral centers (Wills Eye Hospital, Philadelphia, Pennsylvania; Mayo Clinic, Rochester, Minnesota; and Moorfields Eye Hospital, London, England), between January 1, 2000, and August 31, 2017. The study included 6 patients with MD and uveal melanoma. MAIN OUTCOMES AND MEASURES Melanoma response to treatment and development of metastatic disease. RESULTS There were 6 patients, 4 men and 2 women, with MD and uveal melanoma. The mean patient age at melanoma diagnosis was 47 years (median, 43 years; range, 30-67 years), and the tumor involved the choroid in 5 patients (83%) and iris in 1 patient (17%). The diagnosis of MD was known since young adulthood in 2 patients (33%) and was discovered in adulthood in 4 patients (67%). The main clinical features of MD included muscle weakness (n = 5; 83%), myotonia (n = 4; 67%), polychromatic cataract (n = 4; 67%), complications with general anesthesia (n = 4; 67%), myalgia (n = 3; 50%), cardiac arrhythmia (n = 2; 33%), and frontal baldness (n = 2; 33%). Genetic testing revealed MD type 1 (4 of 4 tested patients), and 2 patients demonstrated positive family history of MD with classic clinical features and preferred no testing. Melanoma treatment included plaque radiotherapy (n = 4; 67%), photodynamic therapy (n = 1; 17%), and declined treatment (n = 1; 17%). At follow-up of 6, 6, 41, 42, and 87 months (5 patients), findings included melanoma regression (4 of 5 tumors), melanoma recurrence (1 of 5 tumors), and no metastatic disease (5 of 5 patients). CONCLUSIONS AND RELEVANCE Six adult patients with MD demonstrated uveal melanoma involving the choroid or iris, emphasizing the association between these 2 diseases. Further research seems warranted to explore the pathogenesis of uveal melanoma in MD. These findings support the consideration of ophthalmic examination for uveal melanoma in patients with MD.

Original languageEnglish (US)
Pages (from-to)543-547
Number of pages5
JournalJAMA Ophthalmology
Volume136
Issue number5
DOIs
StatePublished - May 1 2018

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Myotonic Dystrophy
Melanoma
Iris
Choroid
Uveal melanoma
Neoplasms
Myotonia
Myalgia
Alopecia
Muscle Weakness
Photochemotherapy
Genetic Testing
Tertiary Care Centers
England
Cataract

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Dalvin, L. A., Shields, C. L., Pulido, J. S., Sioufi, K., Cohen, V., & Shields, J. A. (2018). Uveal melanoma associated with myotonic dystrophy a report of 6 cases. JAMA Ophthalmology, 136(5), 543-547. https://doi.org/10.1001/jamaophthalmol.2018.0554

Uveal melanoma associated with myotonic dystrophy a report of 6 cases. / Dalvin, Lauren A.; Shields, Carol L.; Pulido, Jose S; Sioufi, Kareem; Cohen, Victoria; Shields, Jerry A.

In: JAMA Ophthalmology, Vol. 136, No. 5, 01.05.2018, p. 543-547.

Research output: Contribution to journalArticle

Dalvin, LA, Shields, CL, Pulido, JS, Sioufi, K, Cohen, V & Shields, JA 2018, 'Uveal melanoma associated with myotonic dystrophy a report of 6 cases', JAMA Ophthalmology, vol. 136, no. 5, pp. 543-547. https://doi.org/10.1001/jamaophthalmol.2018.0554
Dalvin, Lauren A. ; Shields, Carol L. ; Pulido, Jose S ; Sioufi, Kareem ; Cohen, Victoria ; Shields, Jerry A. / Uveal melanoma associated with myotonic dystrophy a report of 6 cases. In: JAMA Ophthalmology. 2018 ; Vol. 136, No. 5. pp. 543-547.
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abstract = "IMPORTANCE Patients with myotonic dystrophy (MD) have an increased risk of malignancy including uveal melanoma. This case series further explores the association between these 2 diseases. OBJECTIVE To describe a cohort of patients with uveal melanoma associated with MD, including a case of iris melanoma, and MD-associated uveal melanoma in relatives. DESIGN, SETTING, AND PARTICIPANTS Retrospective case series at 3 tertiary referral centers (Wills Eye Hospital, Philadelphia, Pennsylvania; Mayo Clinic, Rochester, Minnesota; and Moorfields Eye Hospital, London, England), between January 1, 2000, and August 31, 2017. The study included 6 patients with MD and uveal melanoma. MAIN OUTCOMES AND MEASURES Melanoma response to treatment and development of metastatic disease. RESULTS There were 6 patients, 4 men and 2 women, with MD and uveal melanoma. The mean patient age at melanoma diagnosis was 47 years (median, 43 years; range, 30-67 years), and the tumor involved the choroid in 5 patients (83{\%}) and iris in 1 patient (17{\%}). The diagnosis of MD was known since young adulthood in 2 patients (33{\%}) and was discovered in adulthood in 4 patients (67{\%}). The main clinical features of MD included muscle weakness (n = 5; 83{\%}), myotonia (n = 4; 67{\%}), polychromatic cataract (n = 4; 67{\%}), complications with general anesthesia (n = 4; 67{\%}), myalgia (n = 3; 50{\%}), cardiac arrhythmia (n = 2; 33{\%}), and frontal baldness (n = 2; 33{\%}). Genetic testing revealed MD type 1 (4 of 4 tested patients), and 2 patients demonstrated positive family history of MD with classic clinical features and preferred no testing. Melanoma treatment included plaque radiotherapy (n = 4; 67{\%}), photodynamic therapy (n = 1; 17{\%}), and declined treatment (n = 1; 17{\%}). At follow-up of 6, 6, 41, 42, and 87 months (5 patients), findings included melanoma regression (4 of 5 tumors), melanoma recurrence (1 of 5 tumors), and no metastatic disease (5 of 5 patients). CONCLUSIONS AND RELEVANCE Six adult patients with MD demonstrated uveal melanoma involving the choroid or iris, emphasizing the association between these 2 diseases. Further research seems warranted to explore the pathogenesis of uveal melanoma in MD. These findings support the consideration of ophthalmic examination for uveal melanoma in patients with MD.",
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N2 - IMPORTANCE Patients with myotonic dystrophy (MD) have an increased risk of malignancy including uveal melanoma. This case series further explores the association between these 2 diseases. OBJECTIVE To describe a cohort of patients with uveal melanoma associated with MD, including a case of iris melanoma, and MD-associated uveal melanoma in relatives. DESIGN, SETTING, AND PARTICIPANTS Retrospective case series at 3 tertiary referral centers (Wills Eye Hospital, Philadelphia, Pennsylvania; Mayo Clinic, Rochester, Minnesota; and Moorfields Eye Hospital, London, England), between January 1, 2000, and August 31, 2017. The study included 6 patients with MD and uveal melanoma. MAIN OUTCOMES AND MEASURES Melanoma response to treatment and development of metastatic disease. RESULTS There were 6 patients, 4 men and 2 women, with MD and uveal melanoma. The mean patient age at melanoma diagnosis was 47 years (median, 43 years; range, 30-67 years), and the tumor involved the choroid in 5 patients (83%) and iris in 1 patient (17%). The diagnosis of MD was known since young adulthood in 2 patients (33%) and was discovered in adulthood in 4 patients (67%). The main clinical features of MD included muscle weakness (n = 5; 83%), myotonia (n = 4; 67%), polychromatic cataract (n = 4; 67%), complications with general anesthesia (n = 4; 67%), myalgia (n = 3; 50%), cardiac arrhythmia (n = 2; 33%), and frontal baldness (n = 2; 33%). Genetic testing revealed MD type 1 (4 of 4 tested patients), and 2 patients demonstrated positive family history of MD with classic clinical features and preferred no testing. Melanoma treatment included plaque radiotherapy (n = 4; 67%), photodynamic therapy (n = 1; 17%), and declined treatment (n = 1; 17%). At follow-up of 6, 6, 41, 42, and 87 months (5 patients), findings included melanoma regression (4 of 5 tumors), melanoma recurrence (1 of 5 tumors), and no metastatic disease (5 of 5 patients). CONCLUSIONS AND RELEVANCE Six adult patients with MD demonstrated uveal melanoma involving the choroid or iris, emphasizing the association between these 2 diseases. Further research seems warranted to explore the pathogenesis of uveal melanoma in MD. These findings support the consideration of ophthalmic examination for uveal melanoma in patients with MD.

AB - IMPORTANCE Patients with myotonic dystrophy (MD) have an increased risk of malignancy including uveal melanoma. This case series further explores the association between these 2 diseases. OBJECTIVE To describe a cohort of patients with uveal melanoma associated with MD, including a case of iris melanoma, and MD-associated uveal melanoma in relatives. DESIGN, SETTING, AND PARTICIPANTS Retrospective case series at 3 tertiary referral centers (Wills Eye Hospital, Philadelphia, Pennsylvania; Mayo Clinic, Rochester, Minnesota; and Moorfields Eye Hospital, London, England), between January 1, 2000, and August 31, 2017. The study included 6 patients with MD and uveal melanoma. MAIN OUTCOMES AND MEASURES Melanoma response to treatment and development of metastatic disease. RESULTS There were 6 patients, 4 men and 2 women, with MD and uveal melanoma. The mean patient age at melanoma diagnosis was 47 years (median, 43 years; range, 30-67 years), and the tumor involved the choroid in 5 patients (83%) and iris in 1 patient (17%). The diagnosis of MD was known since young adulthood in 2 patients (33%) and was discovered in adulthood in 4 patients (67%). The main clinical features of MD included muscle weakness (n = 5; 83%), myotonia (n = 4; 67%), polychromatic cataract (n = 4; 67%), complications with general anesthesia (n = 4; 67%), myalgia (n = 3; 50%), cardiac arrhythmia (n = 2; 33%), and frontal baldness (n = 2; 33%). Genetic testing revealed MD type 1 (4 of 4 tested patients), and 2 patients demonstrated positive family history of MD with classic clinical features and preferred no testing. Melanoma treatment included plaque radiotherapy (n = 4; 67%), photodynamic therapy (n = 1; 17%), and declined treatment (n = 1; 17%). At follow-up of 6, 6, 41, 42, and 87 months (5 patients), findings included melanoma regression (4 of 5 tumors), melanoma recurrence (1 of 5 tumors), and no metastatic disease (5 of 5 patients). CONCLUSIONS AND RELEVANCE Six adult patients with MD demonstrated uveal melanoma involving the choroid or iris, emphasizing the association between these 2 diseases. Further research seems warranted to explore the pathogenesis of uveal melanoma in MD. These findings support the consideration of ophthalmic examination for uveal melanoma in patients with MD.

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