Melanoma-associated retinopathy: screening for melanoma-associated retinopathy in patients with cutaneous malignant melanoma

Abstract

Purpose: Melanoma-associated retinopathy (MAR) is a paraneoplastic retinopathy that develops in some patients with cutaneous malignant melanoma (CMM).The syndrome is identified by, and possibly caused by, antibodies reactive with retinal depolarizing bipolar cells. CMM patients lacking indications of vision problems are not usually routinely screened for melanoma-induced retinal hypersensitivity, but may have undergone similar sensitization without losing tolerance or may be in the early stages of MAR. The purpose of this study was to look into the possibility that subclinical and immunologic indications of MAR appear in CMM patients without recognized retinopathies. Methods: Twenty-nine CMM patients (stages II-IV), being treated at the Department of Dermatology (The Saarland University Hospital), were screened to detect abnormalities suggestive of MAR. Our assessment included exploration of ophthalmologic history, ophthalmologic examination, electrophysiology, nyctometry, perimetry, testing of color vision, and serum examination for antiretinal autoantibodies. Parameters for diagnosing MAR were (1) reduced scotopic b-wave amplitude, (2) reduced contrast sensitivity in nyctometry, (3) abnormalities in perimetry, and (4) the identification of antiretinal antibodies, especially against the retinal bipolar cell layer. Results: Two patients had to be excluded due to either bad compliance (n = 1) or a clouding of the media (n = 1). Six of the remaining 27 patients were found to exhibit indications of MAR, showing abnormal results in all of the clinical examinations 1-3. Three of these six patients produced antibodies reactive with ocular tissue, including retinal bipolar cells. These three patients were accordingly classified as affected by MAR. These findings indicate a prevalence of MAR in approximately 10% of the study group. Eighteen of the remaining patients produced abnormal results in at least one of the evaluations for MAR. Patients with MAR-suspicious signs frequently had abnormalities in the Farnsworth Panel D15 tests, mostly in the tritan axis or involving all three color axes at the same time. Conclusions: MAR is widely considered to be a rare, immune-mediated paraneoplastic syndrome. Our screening for indications of MAR in CMM patients identified a much higher prevalence than expected. Impaired color vision in a CMM patient indicates the need for MAR screening.