Melanoma-associated paraneoplastic retinopathy: case report and review of the literature

Abstract

A 51-year-old white male suffering from metastatic malignant melanoma of the skin presented with lymph node metastases and paraneoplastic retinopathy 4 years after resection of the primary tumour. There were no cerebral metastases. Ocular symptoms consisting of night blindness and sensations of 'shimmering lights' persisted after total resection of the inguinal lymph node metastases and administration of dacarbazine and prednisone. Perimetry of both eyes was abnormal with concentric restriction. Electroretinography showed significantly reduced amplitudes in both eyes. Only 11 patients with melanoma-associated retinopathy (MAR) have been described. High titres of autoantibodies against whole retina extract were detected by enzyme-linked immunosorbent assay (ELISA) reactions. Indirect immunohistochemistry showed strong autoantibody activity against retinal bipolar cells.

Melanoma‐associated retinopathy: does autoimmunity prolong survival?

“…Melanoma‐associated retinopathy (MAR) has become an increasingly recognized clinical entity over the past decade. At least 19 cases have now been reported, 18 of them were men 1–19 . Melanoma‐associated retinopathy has been seen only in patients with cutaneous melanoma.…”

Melanoma‐associated retinopathy

“…The positive visual phenomena are described as constant or fluctuating shimmering, pulsating or flickering lights, often worse in bright light . Symptoms usually become bilateral within 4 days–2 months, but less commonly can remain unilateral .…”

“…Although the data are limited, intravenous immunoglobulin and plasma exchange may be more promising options. They tend to be used in patients who have not responded to (or are unsuitable candidates for) other treatments …”

Paraneoplastic Disorders

“…Paraneoplastic retinopathy associated with antibodies to recoverin is known as cancer-associated retinopathy (CAR). 56 As opposed to CAR, these patients present with acute visual loss years or months after the diagnosis of the metastatic disease. Other target antigens that have been described include the tubby-like protein, photoreceptor cell-specific nuclear receptor, and the polypyrimidine tract binding-like protein.…”