Pföhler C, Haus A, Palmowski A, Ugurel S, Ruprecht K W, Thirkill C E, Tilgen W, Reinhold U
Department of Dermatology, The Saarland University Hospital, 66421 Homburg/Saar, Germany.
Br J Dermatol. 2003 Jul;149(1):74-8. doi: 10.1046/j.1365-2133.2003.05377.x.
Melanoma-associated retinopathy (MAR) is a paraneoplastic syndrome with symptoms of night blindness, light sensations, visual loss, defect in visual fields, and reduced b-waves in the electroretinogram. Patients with MAR often suffer from a sudden onset of ocular symptoms that are believed to result from antibody production against melanoma-associated antigens that cross-react with corresponding epitopes on retinal depolarizing bipolar cells.
To correlate the frequency of subclinical symptoms suggestive of MAR in melanoma patients to different stages of disease, patient age, type and thickness of the primary tumour, form of therapy, S-100 level and tumour burden.
We analysed 28 patients with melanoma in stages I-IV (according to the American Joint Committee on Cancer tumour classification) for the presence of subclinical MAR symptoms using scotopic electroretinography, static and kinetic perimetry and nyctometry.
Seven patients had clinical signs and symptoms consistent with MAR, 18 had some indications, while the remaining three had none. We found no correlation between clinical symptoms and stage of disease, tumour burden or S-100 level, but findings suggestive of MAR were observed more frequently in advanced stages of disease.
Subclinical retinal involvement characteristic of MAR appears to be more common than previously suspected in patients with cutaneous malignant melanoma. Our findings in this small cohort seem to indicate that the percentage of patients with symptoms suggestive of MAR is higher in advanced stages of disease. Further clinical studies are required to evaluate if the presence of subclinical symptoms suggestive of MAR is correlated with a worse prognosis and a shortened progression-free and overall survival.
黑色素瘤相关性视网膜病变（MAR）是一种副肿瘤综合征，具有夜盲、光感、视力丧失、视野缺损以及视网膜电图b波降低等症状。MAR患者常突然出现眼部症状，据信这是由于针对黑色素瘤相关抗原产生的抗体与视网膜去极化双极细胞上的相应表位发生交叉反应所致。
将黑色素瘤患者中提示MAR的亚临床症状的频率与疾病的不同阶段、患者年龄、原发肿瘤的类型和厚度、治疗方式、S-100水平及肿瘤负荷相关联。
我们使用暗视视网膜电图、静态和动态视野检查以及暗适应测量法，分析了28例I-IV期（根据美国癌症联合委员会肿瘤分类）黑色素瘤患者是否存在亚临床MAR症状。
7例患者有与MAR一致的临床体征和症状，18例有一些迹象，而其余3例没有。我们发现临床症状与疾病阶段、肿瘤负荷或S-100水平之间无相关性，但在疾病晚期更频繁地观察到提示MAR的表现。
MAR特征性的亚临床视网膜受累在皮肤恶性黑色素瘤患者中似乎比以前怀疑的更为常见。我们在这个小队列中的发现似乎表明，在疾病晚期提示MAR症状的患者百分比更高。需要进一步的临床研究来评估提示MAR的亚临床症状的存在是否与更差的预后以及无进展生存期和总生存期缩短相关。
