Corticosteroid treatment for melanoma-associated retinopathy: effect on visual acuity and electrophysiologic findings.
BACKGROUND
Visual disturbance in the course of melanoma is rare. Specific localized metastases and drug toxic effects are frequently the cause. Recognition of a retinopathy raises several questions when the diagnosis of melanoma-associated retinopathy (MAR) can be confirmed. Descriptions of such patients in dermatologic literature are rare and deserve attention because therapeutic decisions are mandatory.


METHODS
A 70-year-old woman had a first melanoma in 1985 and a second primary melanoma in 1994. Axillary lymph node involvement occurred in November 2000, leading to surgery and chemotherapy. In December 2001, she had sudden bilateral visual loss, with shimmering blobs of color and flickering photopsias. Computed tomography and cerebral magnetic resonance imaging ruled out localized tumor on the eyes or optic nerves or evolution of disease. Ophthalmologic examination revealed a bilateral posterior uveitis, with hyalitis and progressive destruction of retinal pigment. The electrophysiologic data confirmed the diagnosis of MAR. Symptoms improved after systemic corticosteroid therapy, with no relapse after tapering doses despite worsening of melanoma.


CONCLUSIONS
As a rare paraneoplastic visual syndrome possibly leading to blindness, MAR is characterized by bipolar cell involvement without photoreceptor cell impairment. Also, MAR is linked to the presence of autoantibodies directed against melanoma antigens that cross-react with the rod bipolar cells of the retina. Corticosteroid therapy is rarely beneficial. Our case of MAR is noteworthy because it involved a woman, was associated with an uveitis, and improved with corticosteroid therapy.
Jacobzone
Caroline
C
Department of Dermatology, University Hospital of Brest, CHU Brest 29609, France.
Cochard-Marianowski
Catherine
C
Kupfer
Ingrid
I
Bettembourg
Samia
S
Dordain
Yves
Y
Misery
Laurent
L
Cochener
Beatrice
B
Sassolas
Bruno
B
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D003937:Diagnosis, Differential; D004594:Electrophysiology; D005260:Female; D006801:Humans; D008545:Melanoma / Q000150:complications*; D016609:Neoplasms, Second Primary / Q000150:complications; D010257:Paraneoplastic Syndromes / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D012164:Retinal Diseases / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D012878:Skin Neoplasms / Q000150:complications*; D015354:Vision, Low / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D014792:Visual Acuity
D000305:Adrenal Cortex Hormones