Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0278883 (metastatic melanoma)
 6,224 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The case history of a patient with metastatic melanoma obstructing the lacrimal sac is presented. To our knowledge, this case represents a unique metastatic pattern that has not been previously reported. The patient was first treated for a melanoma of the left arm, which was excised in continuity with the axillary lymph glands. She was free of disease for 3 years until she developed metastatic disease causing obstruction of the ipsilateral lacrimal sac. Anatomical details of the metastasis were provided by computed axial tomography. Treatment consisted of excision of the metastatic lesion with reconstruction using forehead and intranasal mucosal flaps, followed by irradiation, hyperthermia, and multiple-drug chemotherapy. Emphasis is placed here on the differential diagnosis of orbital adnexal tumors.
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PMID:Metastatic melanoma of the lacrimal sac. 408 23

An 81-year-old woman with primary acquired melanosis of the conjunctiva had multinodular invasive malignant melanoma, with one nodule engulfing the superior lacrimal punctum. At exenteration, the lacrimal sac was noted to be involved with melanoma, and an en bloc resection of the orbital contents along with the medial orbital wall and the medial wall of the maxillary antrum was performed to excise the lacrimal drainage apparatus. In situ melanoma was found in the superior canaliculus with invasive melanoma in the lacrimal sac. In situ melanoma was also found in the ductules of the lacrimal gland and the accessory lacrimal glands of the fornix. The patient died 8 months later of metastatic melanoma. The involvement of the lacrimal drainage apparatus by primary acquired melanosis or in situ melanoma makes clinical monitoring and management difficult.
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PMID:Malignant melanoma of the lacrimal sac complicating primary acquired melanosis of the conjunctiva. 918 54

Adjuvant radiation treatment is often offered for lacrimal sac tumors. However, due to the adjacent critical structures, conventional radiation technique may result in severe side effects. We have treated two patients with lacrimal sac tumors using optically guided stereotactic radiotherapy. One patient with lacrimal sac melanoma was treated with optical-guidance intensity-modulated radiotherapy (IMRT). The other with mixed transitional and squamous cell carcinoma was treated with optical-guidance 3-D conformal radiation. Dose volume analysis revealed excellent target coverage and sparing of critical structures. Both patients tolerated the treatment well with no significant acute or late side effects. One patient died of metastatic melanoma 30 months after radiation; another died of coexisting disease 41 months after radiation. Both had no clinical evidence of local recurrence at the time of death. Our report show that optically guided stereotactic radiotherapy is well tolerated. It offers excellent tumor coverage and sparing of critical structures. It can be used for tumors adjacent to radiation sensitive critical structures such as skull base tumors.
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PMID:Optically guided stereotactic radiotherapy for lacrimal sac tumors: a report on two cases. 1819 22

Primary melanoma of the lacrimal sac is a rare entity, with high mortality and a propensity for recurrence. This report details a patient with widely metastatic melanoma discovered after biopsy of abnormal lacrimal sac tissue during routine dacryocystorhinostomy. The patient subsequently underwent local excision and treatment with pembrolizumab. At the time of this writing, it has been 24 months since the original diagnosis with resolution of his lacrimal and orbital lesions and improvement in all metastatic lesions. This case highlights the growing use of cancer genomics and immunotherapeutic agents in orbital aspects of oncology and reinforces the role of a multidisciplinary approach in the treatment of such diseases.
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PMID:Primary Melanoma of the Lacrimal Sac Treated With Pembrolizumab. 3307 59