title: Melanoma-associated retinopathy: high frequency of subclinical findings in patients with melanoma.
abstract: BACKGROUND
  Melanoma-associated retinopathy (MAR) is a paraneoplastic syndrome with symptoms of night blindness, light sensations, visual loss, defect in visual fields, and reduced b-waves in the electroretinogram. Patients with MAR often suffer from a sudden onset of ocular symptoms that are believed to result from antibody production against melanoma-associated antigens that cross-react with corresponding epitopes on retinal depolarizing bipolar cells.
  
  
  OBJECTIVE
  To correlate the frequency of subclinical symptoms suggestive of MAR in melanoma patients to different stages of disease, patient age, type and thickness of the primary tumour, form of therapy, S-100 level and tumour burden.
  
  
  METHODS
  We analysed 28 patients with melanoma in stages I-IV (according to the American Joint Committee on Cancer tumour classification) for the presence of subclinical MAR symptoms using scotopic electroretinography, static and kinetic perimetry and nyctometry.
  
  
  RESULTS
  Seven patients had clinical signs and symptoms consistent with MAR, 18 had some indications, while the remaining three had none. We found no correlation between clinical symptoms and stage of disease, tumour burden or S-100 level, but findings suggestive of MAR were observed more frequently in advanced stages of disease.
  
  
  CONCLUSIONS
  Subclinical retinal involvement characteristic of MAR appears to be more common than previously suspected in patients with cutaneous malignant melanoma. Our findings in this small cohort seem to indicate that the percentage of patients with symptoms suggestive of MAR is higher in advanced stages of disease. Further clinical studies are required to evaluate if the presence of subclinical symptoms suggestive of MAR is correlated with a worse prognosis and a shortened progression-free and overall survival.
authors.affiliation: Department of Dermatology, The Saarland University Hospital, 66421 Homburg/Saar, Germany. hacpfo@uniklinik-saarland.de
authors.forename: C
authors.initials: C
authors.lastname: Pföhler
authors.forename: A
authors.initials: A
authors.lastname: Haus
authors.forename: A
authors.initials: A
authors.lastname: Palmowski
authors.forename: S
authors.initials: S
authors.lastname: Ugurel
authors.forename: K W
authors.initials: KW
authors.lastname: Ruprecht
authors.forename: C E
authors.initials: CE
authors.lastname: Thirkill
authors.forename: W
authors.initials: W
authors.lastname: Tilgen
authors.forename: U
authors.initials: U
authors.lastname: Reinhold
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000150:complications* / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D009755:Night Blindness / Q000209:etiology; D010257:Paraneoplastic Syndromes / Q000209:etiology*; D012164:Retinal Diseases / Q000209:etiology*; D012878:Skin Neoplasms / Q000150:complications* / Q000473:pathology