An unusual case of melanoma-associated retinopathy

Paraneoplastic syndromes pose some of the most baffling clinical presentations encountered in medicine. Brain degenerations with accompanying dementia, peripheral neuritis and the Eaton-Lambert myasthenia gravis syndrome comprise a few examples of the clinical conditions which manifest as remote expressions of cancer. The uncontrolled expression of key proteins by cancers is thought responsible for inciting autoimmune reactions which affect the corresponding component within the host. Paraneoplastic retinopathies have been reported to occur in association with a variety of different types of cancer. Indications of retinal hypersensitivity manifest in these patients through the production of autoantibodies reactive with specific retinal cells or antigens. This form of vision loss is suspected to develop in ways similar to that proposed for other paraneoplasias, as a form of ocular hypersensitivity induced by the cancer's aberrant expression of specific retinal proteins. The subject of this report had a history of vision abnormalities linked with the surgical removal of a melanoma. The authors sought evidence of retinal hypersensitivity through a series of immunologic assays described by others to reveal a recognizable pattern of autoantibody reactions characteristic of patients with melanoma associated retinopathy, the MAR syndrome. Although autoantibodies were present, the authors were unable to identify any single retinal antigen or cell type which might represent the target of the patient's ostensibly autoimmune reactions.