title: Clinical and histologic findings in patients with uveal melanomas after taking tumor necrosis factor-α inhibitors.
abstract: OBJECTIVE
  To describe the progression of uveal melanocytic lesions to melanomas after initiation of tumor necrosis factor-α (TNF-α) inhibitors.
  
  
  METHODS
  We report 3 cases of uveal melanoma occurring after treatment with TNF-α inhibitors, 2 from Mayo Clinic and 1 from Yale University. The study took place from February 27, 2009, through July 15, 2013.
  
  
  RESULTS
  Two women and one man with inflammatory disease who received TNF-α inhibitors had subsequent development of uveal melanomas. The 2 women had inflammatory bowel disease and had been followed up for melanocytic tumors that grew markedly within 1 year after beginning treatment with TNF-α inhibitors to the point of requiring treatment. One had histologic confirmation of the melanoma. The male patient had rheumatoid arthritis that was being treated with TNF-α inhibitors. Serial ultrasonography was performed to monitor bilateral diffuse scleritis, and within 16 months of initiation of TNF-α inhibitor therapy, a choroidal mass was detected that continued to grow over the next 3 months. The patient elected to have enucleation, which revealed uveal melanoma and thinning of the sclera from the previous scleritis.
  
  
  CONCLUSIONS
  Our 3 cases of uveal melanocytic tumors occurring after the use of TNF-α inhibitors add to the growing literature suggesting a correlation between TNF-α inhibitors and the development of malignant neoplasms. Considering the association between cutaneous melanoma and TNF-α inhibitors, we recommend that patients have an eye examination before initiation of TNF-α inhibitors, and those with preexisting nevi should be followed up at regular intervals.
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, MN.
authors.forename: Gena
authors.initials: G
authors.lastname: Damento
authors.affiliation: Department of Ophthalmology, Yale University, New Haven, CT.
authors.forename: Shaheen C
authors.initials: SC
authors.lastname: Kavoussi
authors.affiliation: Department of Ophthalmology, Yale University, New Haven, CT.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Materin
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, MN; Division of Anatomic Pathology, Mayo Clinic, Rochester, MN.
authors.forename: Diva R
authors.initials: DR
authors.lastname: Salomão
authors.affiliation: VitreoRetinal Surgery, PA, Edina, MN.
authors.forename: Polly A
authors.initials: PA
authors.lastname: Quiram
authors.forename: Saranya
authors.initials: S
authors.lastname: Balasubramaniam
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, MN.
authors.forename: Soranya
authors.initials: S
authors.lastname: Balasubramaniam
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, MN; Department of Molecular Medicine, Mayo Clinic, Rochester, MN. Electronic address: pulido.jose@mayo.edu.
authors.forename: Jose S
authors.initials: JS
authors.lastname: Pulido
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007107:Immune System / Q000187:drug effects*; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008545:Melanoma / Q000139:chemically induced* / Q000473:pathology; D008875:Middle Aged; D014409:Tumor Necrosis Factor-alpha / Q000009:adverse effects* / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D014604:Uveal Neoplasms / Q000139:chemically induced* / Q000473:pathology
chemical_list: D014409:Tumor Necrosis Factor-alpha