Focusing on Eye Melanoma

Did you know melanoma can affect the eyes? In fact, it's the most common and most dangerous form of eye cancer in adults. Half the time it spreads and if that happens it's almost 100-percent fatal.

Today we take a look at a breakthrough therapy that's giving patients more time.

Molly Larkin's kids are the focus of her life, but eye cancer could keep her from watching them grow up.

"I just don't dwell on the what-ifs," says Uveal Melanoma Patient Molly Larkin.

Molly was diagnosed with ocular melanoma ten years ago. She was treated and thought she was in the clear.

"By the time we got to eight years I wasn't too worried about it anymore," says Larkin.

A routine exam showed molly was among the 50 percent of patients in whom the fatal cancer spreads to the liver.

Once that happens, Doctor Carin Gonsalves says the outlook is grim.

"Their overall survival is less than six months with a one year survival of about 13 percent," Dr. Carin F. Gonsalves, MD, at the Thomas Jefferson University Hospital.

Now a new therapy, immunoembolization, could improve those odds.

Doctors inject an immune system booster directly into the arteries that supply blood to tumors in the liver. The booster blocks blood flow and starves the tumor.

"This GM-CSF stimulates the body's immune system to recognize the tumor as foreign and therefore kill it," Dr. Gonsalves explains.

The technique is prolonging life expectancy from less than six months without treatment to an average of two years, time this mom is thankful for.

Thomas Jefferson University Hospital developed the therapy and is the only hospital in the world offering it.

The injection is not a cure. Patients come in once a month for the treatment and must stay overnight for observation. Because of the aggressive nature of this cancer, patients often require treatment for life.

MEDICAL BREAKTHROUGHS
RESEARCH SUMMARY

TOPIC: Focusing on Eye Melanoma
REPORT: MB # 3581

BACKGROUND: Melanoma is a type of cancer that develops in melanin producing cells, cells that pigment your skin. The eyes also can develop melanoma because they have melanin-producing cells. Eye melanoma, also called ocular melanoma, is difficult to detect because it forms in part of the eye that you can't see when looking into the mirror and it does not usually cause any symptoms. When symptoms do occur, they can include: a growing dark spot on the iris, a change in the shape of the pupil, a sensation of flashing lights, loss of peripheral vision, blurry vision in one eye, and specs of dust in your vision (floaters). (Source: www.mayoclinic.com)

CAUSES: Doctors do not know exactly what causes eye melanoma. It occurs when errors develop in the DNA of healthy eye cells. The DNA errors tell the cells to grow and multiply. Then they accumulate in the eye and turn into eye melanoma. Eye melanoma mostly develops in the cells of the vascular layer of the eye (uvea), which is between the retina and the sclera (the white area of the eye). It can develop in the front part of the uvea, the iris, or the back part, the choroid layer. Also, eye melanoma can develop in the conjunctiva, the outer layer on the front of the eye, in the socket that surrounds the eyeball and on the eyelid; however, these types are very rare. Some risk factors for developing melanoma include: light eye color, being Caucasian, certain inherited skin disorders, increasing age, and exposure to ultraviolet light. (Source: www.mayoclinic.com)

TREATMENT: Eye melanoma can cause certain complications. It increases pressure within the eye, which is called glaucoma. It can also lead to vision loss that can also cause retinal detachment. It can spread to other areas of the body, like the liver, bones, and lungs. Treatment options will depend on the size and location of the eye melanoma. For small melanomas, surgery can be done to remove the melanoma and a tiny area of the healthy tissue. Surgery to remove small melanoma in the iris is called iridectomy. Surgery to remove it in the choroid is called choroidectomy. For large eye tumors, surgery can be done to remove the entire eye, called enucleation. Radiation therapy can also be used to treating small to medium-sized melanomas. Laser treatment can also be used to kill the melanoma cells and extreme cold treatments, called cryotherapy. However, cryotherapy is not a common one. (Source: www.mayoclincic.com)

NEW TECHNOLOGY: Among patients who have eye melanoma, 50 percent of patients will have it lead to liver cancer. Physicians at Thomas Jefferson University Hospital developed a new therapy to treat these patients, called Immunoembolization. They inject drugs that stimulate or modulate the immune responses, called cytokines, into the arteries that supply the liver, along with the embolization of the hepatic artery. Conventional treatment only offers a five month survival rate, but Immunoembolization offers an average 14.5 month survival rate. (Source: www.jeffersonhospital.org) During the phase I study of the safety of immunoembolization, 39 patients with malignant liver tumors with 34 of them having primary uveal melanoma were enrolled. They were given an infusion dose of GM-CSF every four weeks. Patients who completed two cycles of treatments were monitored for hepatic antitumor response and survival rates. Results showed that 31 patients with uveal melanoma demonstrated two complete responses, eight partial responses, and ten occurrences of stable disease in their hepatic metastases. Multivariate analyses indicated that female sex, high doses of GM-CSF and regression of hepatic metastases (complete and partial responses) were related to longer overall survival. (Source: www.ncbi.nlm.nih.gov)

FOR MORE INFORMATION, PLEASE CONTACT:

Carin F. Gonsalves, MD
Associate Professor of Radiology
Division of Interventional Radiology
Thomas Jefferson University Hospital
Jefferson's Kimmel Cancer Center
Carin.gonsalves@jefferson.edu


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