Proton beam therapy followed by pembrolizumab for giant ocular surface conjunctival malignant melanoma: A case report

Matsuo,Toshihiko; Yamasaki,Osamu; Tanaka,Takehiro; Katsui,Kuniaki; Waki,Takahiro

doi:10.3892/mco.2021.2445

Proton beam therapy followed by pembrolizumab for giant ocular surface conjunctival malignant melanoma: A case report

Authors:
- Toshihiko Matsuo
- Osamu Yamasaki
- Takehiro Tanaka
- Kuniaki Katsui
- Takahiro Waki
View Affiliations

Affiliations: Regenerative and Reconstructive Medicine (Ophthalmology), Okayama University Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama 700‑8558, Japan, Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700‑8558, Japan, Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700‑8558, Japan, Division of Radiation Oncology, Department of Radiology, Kawasaki Medical School, Kurashiki, Okayama 701‑0192, Japan, Department of Radiology, Tsuyama Chuo Hospital, Tsuyama, Okayama 708‑0841, Japan
Published online on: November 18, 2021 https://doi.org/10.3892/mco.2021.2445
Article Number: 12
Copyright: © Matsuo et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The present study describes proton beam therapy as a clinical option to achieve local control of giant conjunctival melanoma in an aged person, instead of orbital exenteration. An 80‑year‑old woman with one‑year history of left‑eye injection and hemorrhage experienced rapid growth of the ocular surface black mass. At the initial visit, a black, elastic hard, hemorrhage‑prone, thickened mass in the size of 30x40 mm with a presumed wide stalk covered the total area of the lid fissure on the left side. Biopsy of the mass demonstrated anomalous melanin‑containing cells in fibrin and hemorrhage, which were positive for cocktail‑mix antibodies against tyrosinase, melanoma antigen recognized by T cells‑1 and human melanoma black‑45, indicative of malignant melanoma. One month after the initial visit, the patient underwent proton beam therapy at the total dose of 70.4 Gy (relative biological effectiveness) in 32 fractions (~10 min each) in one and a half months. One month after the end of proton beam therapy, 3.5 months from the initial visit, the patient was found by computed tomographic scan to have multiple metastatic lesions in bilateral lung fields. With the evidence of absent BRAF mutation, the patient underwent intravenous administration of pembrolizumab 77.2 mg every three weeks five times in total. Then, three months after proton beam therapy, ocular surface melanoma almost subsided and the clear cornea allowed visualization of the intraocular lens inside the eye. In three weeks, spontaneous corneal perforation was plugged with iris incarceration. The patient died suddenly of unknown cause 7.5 months from the initial visit. The local control of giant conjunctival melanoma was achieved by proton beam therapy, leading to patient's satisfaction and better quality of life. Proton beam therapy, followed by immune checkpoint inhibitors, would become the future standard of care for unresectable giant conjunctival melanoma.

View Figures

View References

1	Matsuo T, Ogino Y, Ichimura K, Tanaka T and Kaji M: Clinicopathological correlation for the role of fluorodeoxyglucose positron emission tomography computed tomography in detection of choroidal malignant melanoma. Int J Clin Oncol. 19:230–239. 2014.PubMed/NCBI View Article : Google Scholar
2	Matsuo T, Tanaka T and Yamasaki O: Lacrimal sac malignant melanoma in 15 Japanese patients: Case report and literature review. J Investig Med High Impact Case Rep. 7(2324709619888052)2019.PubMed/NCBI View Article : Google Scholar
3	Seregard S: Conjunctival melanoma. Surv Ophthalmol. 42:321–350. 1998.PubMed/NCBI View Article : Google Scholar
4	Vora GK, Demirci H, Marr B and Mruthyunjaya P: Advances in the management of conjunctival melanoma. Surv Ophthalmol. 62:26–42. 2017.PubMed/NCBI View Article : Google Scholar
5	Jain P, Finger PT, Fili M, Damato B, Coupland SE, Heimann H, Kenawy N, Brouwer NJ, Marinkovic M, Van Duinen SG, et al: Conjunctival melanoma treatment outcomes in 288 patients: A multicentre international data-sharing study. Br J Ophthalmol. 105:1358–1364. 2021.PubMed/NCBI View Article : Google Scholar
6	Ballo MT and Ang KK: Radiotherapy for cutaneous malignant melanoma: Rationale and indications. Oncology (Williston Park). 18:99–110, 113-114. 2004.PubMed/NCBI
7	Gorayski P, Burmeister B and Foote M: Radiotherapy for cutaneous melanoma: Current and future applications. Future Oncol. 11:525–534. 2015.PubMed/NCBI View Article : Google Scholar
8	López F, Rodrigo JP, Cardesa A, Triantafyllou A, Devaney KO, Mendenhall WM, Haigentz M Jr, Strojan P, Pellitteri PK, Bradford CR, et al: Update on primary head and neck mucosal melanoma. Head Neck. 38:147–155. 2016.PubMed/NCBI View Article : Google Scholar
9	Grant-Freemantle MC, O'Neill BL and Clover AJP: The effectiveness of radiotherapy in the treatment of head and neck mucosal melanoma: Systematic review and meta-analysis. Head Neck. 43:323–333. 2021.PubMed/NCBI View Article : Google Scholar
10	Wuestemeyer H, Sauerwein W, Meller D, Chauvel P, Schueler A, Steuhl KP, Bornfeld N and Anastassiou G: Proton radiotherapy as an alternative to exenteration in the management of extended conjunctival melanoma. Graefes Arch Clin Exp Ophthalmol. 244:438–446. 2006.PubMed/NCBI View Article : Google Scholar
11	Westekemper H, Anastassiou G, Sauerwein W, Chauvel P, Bornfeld N, Steuhl KP and Meller D: Analysis of ocular surface alterations following proton beam radiation in eyes with conjunctival malignant melanoma. Ophthalmologe. 103:588–595. 2006.PubMed/NCBI View Article : Google Scholar : (In German).
12	Krause L, Mladenova A, Bechrakis NE, Kreusel KM, Plath T, Moser L and Foerster M: Treatment modalities for conjunctival melanoma. Klin Monbl Augenheilkd. 226:1012–1016. 2009.PubMed/NCBI View Article : Google Scholar : (In German).
13	Maschi-Cayla C, Doyen J, Gastaud P and Caujolle JP: Conjunctival melanomas and proton beam therapy. Acta Ophthalmol. 91(e647)2013.PubMed/NCBI View Article : Google Scholar
14	Scholz SL, Hérault J, Stang A, Griewank KG, Meller D, Thariat J, Steuhl KP, Westekemper H and Sauerwein W: Proton radiotherapy in advanced malignant melanoma of the conjunctiva. Graefes Arch Clin Exp Ophthalmol. 257:1309–1318. 2019.PubMed/NCBI View Article : Google Scholar
15	Thariat J, Salleron J, Maschi C, Fevrier E, Lassalle S, Gastaud L, Baillif S, Claren A, Baumard J, Herault J and Caujolle JP: Oncologic and visual outcomes after postoperative proton therapy of localized conjunctival melanomas. Radiation Oncol. 14(239)2019.PubMed/NCBI View Article : Google Scholar
16	Zenda S, Kawashima M, Nishio T, Kohno R, Nihei K, Onozawa M, Arahira S and Ogino T: Proton beam therapy as a nonsurgical approach to mucosal melanoma of the head and neck: A pilot study. Int J Radiat Oncol Biol Phys. 81:135–139. 2011.PubMed/NCBI View Article : Google Scholar
17	Fuji H, Yoshikawa S, Kasami M, Murayama S, Onitsuka T, Kashiwagi H and Kiyohara Y: High-dose proton beam therapy for sinonasal mucosal malignant melanoma. Radiat Oncol. 9(162)2014.PubMed/NCBI View Article : Google Scholar
18	Sakurai H, Ishikawa H and Okumura T: Proton beam therapy in Japan: Current and future status. Jpn J Clin Oncol. 46:885–892. 2016.PubMed/NCBI View Article : Google Scholar
19	Larsen AC, Dahmcke CM, Dahl C, Siersma VD, Toft PB, Coupland SE, Prause JU, Guldberg P and Heegaard S: A retrospective review of conjunctival melanoma: Presentation, treatment and outcome and an investigation of features associated with BRAF mutations. JAMA Ophthalmol. 133:1295–1303. 2015.PubMed/NCBI View Article : Google Scholar
20	Kiyohara T, Tanimura H, Miyamoto M, Shijimaya T, Nagano N, Nakamaru S, Makimura K and Iwai H: Two cases of BRAF-mutated, bulbar conjunctival melanoma, and review of the published literature. Clin Exp Dermatol. 45:207–211. 2020.PubMed/NCBI View Article : Google Scholar
21	Matsuo T and Yamasaki O: Vogt-Koyanagi-Harada disease-like posterior uveitis in the course of nivolumab (anti-PD-1 antibody), interposed by vemurafenib (BRAF inhibitor), for metastatic cutaneous malignant melanoma. Clin Case Rep. 5:694–700. 2017.PubMed/NCBI View Article : Google Scholar