Melanoma-associated retinopathy: a paraneoplastic autoimmune complication.
OBJECTIVE
To study 11 patients with melanoma-associated retinopathy (MAR) to clarify the reliability of various methods of diagnostic testing, to determine the underlying antigenic retinal proteins, and to study the clinical histories and types of associated melanomas.


METHODS
Clinical data were obtained from patients with melanoma who developed marked visual problems. Testing included electroretinography, kinetic visual fields, comparative studies of Western blots, and indirect immunohistologic examination to detect antiretinal antibodies, as well as proteomic studies to identify underlying antigenic retinal proteins.


RESULTS
Patients with MAR typically have rapid onset of photopsias, scotomata, and loss of central or paracentral vision. Ophthalmoscopy seldom shows significant changes early, but electroretinograms are abnormal. Results of Western blots and immunohistologic examination can show antiretinal antibodies but not always. Most patients (9 of 11) had a strong family history of autoimmune disorders. Any type of melanoma (cutaneous, choroidal, ciliary body, or choroidal nevi) may be associated with this paraneoplastic autoimmune reactivity. MAR may precede or follow the diagnosis of melanoma. Patients with MAR have the same antigenic retinal proteins that have been associated with cancer-associated retinopathy. In addition, 2 new antigenic retinal proteins, aldolase A and aldolase C, were found.


CONCLUSIONS
There was a high prevalence of positive family histories of autoimmune disease in patients with MAR. To confirm the disorder, multiple clinical and serum diagnostic techniques (Western blot or indirect immunohistologic examination) are needed. Two newly observed antigenic retinal proteins, aldolase A and aldolase C, are associated with MAR.
Lu
Ying
Y
Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, 1000 Wall St, Ann Arbor, MI 48105, USA.
Jia
Lin
L
He
Shirley
S
Hurley
Mary C
MC
Leys
Monique J
MJ
Jayasundera
Thiran
T
Heckenlively
John R
JR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood*; D001324:Autoantigens / Q000032:analysis*; D001327:Autoimmune Diseases / Q000209:etiology / Q000276:immunology*; D015153:Blotting, Western; D004591:Electrophoresis, Polyacrylamide Gel; D004596:Electroretinography; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D005634:Fructose-Bisphosphate Aldolase / Q000032:analysis; D006801:Humans; D008297:Male; D008545:Melanoma / Q000276:immunology* / Q000473:pathology; D008875:Middle Aged; D010257:Paraneoplastic Syndromes / Q000209:etiology / Q000276:immunology*; D012164:Retinal Diseases / Q000209:etiology / Q000276:immunology*; D012607:Scotoma / Q000209:etiology; D012878:Skin Neoplasms / Q000276:immunology / Q000473:pathology; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; D014604:Uveal Neoplasms / Q000276:immunology / Q000473:pathology; D014794:Visual Fields
D001323:Autoantibodies; D001324:Autoantigens; D005634:Fructose-Bisphosphate Aldolase