Gamma-Glutamyl Transpeptidase in the Prognosis of Patients with Uveal Malignant Melanoma

Felberg, Norma N T.; Shields, Jerr Y A.; Maguire, J.; Piperata, Susan; Amsel, J.

doi:10.1016/0002-9394(83)90266-0

Cited by 16 publications

(7 citation statements)

References 13 publications

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“…Although surveillance regimens vary, some studies suggest LDH and GGT are the most sensitive liver function tests for uveal melanoma and are most often elevated with advanced hepatic involvement. 27–29 …”

Section: Surveillancementioning

confidence: 99%

“…Although surveillance regimens vary, some studies suggest that lactate dehydrogenase and cglutamyl transferase are the most sensitive liver function tests for uveal melanoma and are most often elevated in patients who have advanced hepatic involvement. [56][57][58] Local and distant metastases have been reported decades after primary therapy; however, in view of the lack of evidence for the benefit of any specific surveillance strategy, particularly for late relapse, recommendations for these patients and their providers remain uncertain.…”

Section: Surveillancementioning

confidence: 99%

See 1 more Smart Citation

Uveal melanoma: From diagnosis to treatment and the science in between

Chattopadhyay

Kim

Gombos

et al. 2016

Cancer

310

258

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Melanomas of the choroid, ciliary body, and iris of the eye are collectively known as uveal melanomas. These cancers represent 5% of all melanoma diagnoses in the United States, and their age-adjusted risk is 5 per 1 million population. These less frequent melanomas are dissimilar to their more common cutaneous melanoma relative, with differing risk factors, primary treatment, anatomic spread, molecular changes, and responses to systemic therapy. Once uveal melanoma becomes metastatic, therapy options are limited and are often extrapolated from cutaneous melanoma therapies despite the routine exclusion of patients with uveal melanoma from clinical trials. Clinical trials directed at uveal melanoma have been completed or are in progress, and data from these well designed investigations will help guide future directions in this orphan disease. Cancer 2016;122:2299-312. V C 2016 American Cancer Society.KEYWORDS: breast cancer 1-associated protein 1 (BAP1), choroidal melanoma, diagnosis, guanine nucleotide binding protein a11 (GNA11), guanine nucleotide-binding protein Q polypeptide (GNAQ), ocular melanoma, review, science, treatment, uveal melanoma. BACKGROUND AND EPIDEMIOLOGYUveal melanoma is the most common primary intraocular malignancy. The uveal tract is the pigmented layer of the globe encompassing the iris, ciliary body, and choroid (Fig. 1). The terms choroidal melanoma and ocular melanoma are alternative terms for this cancer, because most of the uveal tract is choroidal. However, the term ocular melanoma should be avoided, because it implies the inclusion of conjunctival and adnexal melanomas, which behave and are managed like cutaneous rather than uveal primaries. Approximately 1500 new cases of uveal melanoma are diagnosed in the United States each year, most commonly arising in the choroid followed by the ciliary body. Iris melanomas are the least common location for uveal melanoma (Fig. 2).1 Although the disease has no sex preference, it is more common in middle-aged Caucasians (median age at presentation, 58 years). Risk factors include the presence of a choroidal nevus, which can be observed in 7% to 8% of the Caucasian population. Certain skin conditions, such as dysplastic nevus syndrome and nevus of Ota, are also associated with uveal melanoma.2 It has been theorized by some investigators that exposure to ultraviolet radiation increases the risk of this neoplasia, but this has not been definitively proven. Whereas certain somatic mutations are associated with neoplastic growth and distant metastasis, the malignancy is not inherited in a traditional genetic fashion, although it is believed that individuals who have germline breast cancer 1 (BRCA1)-associated protein 1 (BAP1) mutations are at higher risk for uveal and cutaneous melanoma as well as mesothelioma and renal cancers.

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Section: Surveillancementioning

confidence: 99%

Section: Surveillancementioning

confidence: 99%

Uveal melanoma: From diagnosis to treatment and the science in between

Chattopadhyay

Kim

Gombos

et al. 2016

Cancer

310

258

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“…It was, and still is, unclear what constitutes an adequate screening program, however 5, 15. Few papers devoted to the clinical and laboratory findings of patients with metastatic uveal melanoma exist,5, 13, 14, 16–18 and two recent major reviews on the treatment of primary and metastatic uveal melanoma, respectively, do not discuss screening at all 19, 20…”

mentioning

confidence: 99%

Screening for metastatic malignant melanoma of the uvea revisited

Eskelin

Pyrhönen

Summanen

et al. 1999

Cancer

141

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BACKGROUND The purpose of the current study was to assess the value of routine imaging and liver function tests in detecting metastases from malignant melanoma of the uvea. METHODS Forty‐six consecutive patients diagnosed with metastatic uveal melanoma between 1985 and 1996 who had participated in a screening program that included annual liver function tests (LFT), chest X‐ray, and abdominal ultrasonography (US) were eligible for this retrospective cohort study. Main outcome measures were the sensitivity of screening tests, presence of symptoms, recurrence free interval, and metastatic burden. RESULTS Metastases were diagnosed in 74% of patients (95% confidence interval [95% CI], 59–86) at screening and in 26% (95% CI, 14–41) when the patient consulted a physician because of symptoms that developed before the next scheduled visit. Of all the patients, 59% (95% CI, 43–73) were asymptomatic, and 80% (95% CI, 66–91) had only hepatic metastases. The median recurrence free interval, greatest dimension of the largest metastasis, and metastatic burden of the two groups did not differ. US was diagnostic in 78% (95% CI, 64–89), at least 1 LFT test was abnormal in 70% of patients (95% CI, 54–82), and a chest X‐ray was abnormal in 2% of patients (95% CI, 0–12). LFTs and US did not reveal hepatic metastases in 33% and 4% of patients, respectively. The sensitivity of individual LFTs ranged from 0.27 to 0.67, and their specificity from 0.90 to 0.96, with lactate dehydrogenase being the most sensitive LFT used. CONCLUSIONS The authors believe that annual screening with LFTs and abdominal US will identify 59% of patients while they are still asymptomatic and that semiannual screening will detect >95% of such patients. Chest X‐ray has a very low yield and is recommended only at baseline to exclude metastatic disease to the eye and if pulmonary symptoms develop. Cancer 1999;85:1151–9. © 1999 American Cancer Society.

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“…LFTs traditionally have been used for screening of hepatic metastases of skin and uveal melanoma. 5,6,8,9,[13][14][15][16][17][18]29 A panel of four liver enzymes identified 70% of our patients with metastases, including 2 patients who had a falsely negative abdominal US. The specificity of all four LFTs among the present selected, predominantly elderly patients screened was high, translating to a false-positive rate of 10% or less.…”

Section: Discussionmentioning

confidence: 99%

“…These figures compare favorably with programs that used liver imaging only if symptoms, abnormal physical examination, or LFTs indicated them. In the largest and most recent such series, 9 of 145 patients, 30% (95% CI, 23-39) were asymptomatic, metastases involved only the liver in 56% (95% CI, 47-67), and the frequency of a positive chest X-ray was 24% (95% CI, [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. The frequency of pulmonary metastases in earlier, smaller series likewise ranged from 17% to 28%.…”

Section: Discussionmentioning

confidence: 99%