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High-risk histopathologic features in local advanced conjunctival melanoma
Tianyu Zhu1, Chunyan Zong1, Yongyun Li1
1Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Acta Ophthalmologica
|February 29, 2024
Summary
Conjunctival melanoma (CoM) prognosis is worsened by tumor thickness ≥ 4mm, ulceration, regression with tumor-infiltrating lymphocytes (TILs), and BRAF V600E mutation. BRAF V600E also correlates with PD-1 and PD-L1 expression.
Area of Science:
- Ophthalmology
- Oncology
- Pathology
Background:
- Conjunctival melanoma (CoM) is a rare ocular malignancy.
- Identifying prognostic factors is crucial for patient management and treatment strategies.
Purpose of the Study:
- To determine high-risk histopathologic and molecular features associated with local recurrence, nodal metastasis, distant metastasis (DM), and disease-specific death (DSD) in CoM.
- To correlate molecular markers with clinical outcomes in CoM.
Main Methods:
- Retrospective analysis of 90 CoM patients diagnosed between 2008-2023.
- Immunohistochemistry for BRAF V600E, NRAS Q61R, CD117, PD-1, and PD-L1.
- Cox regression and Kaplan-Meier survival analyses to identify risk factors.
Main Results:
- Pathologic risk factors for DM included ulceration and regression. Tumor thickness ≥ 4mm and regression were significant risk factors for DSD.
- Ulceration in thinner tumors (<4mm) increased risk for nodal metastasis, DM, and DSD. Regression with TILs correlated with higher DM and DSD risk.
- BRAF V600E mutation was an independent risk factor for DM. BRAF V600E expression positively correlated with vascular invasion, PD-1, and PD-L1 expression.
Conclusions:
- Tumor thickness ≥ 4mm, ulceration, regression with TILs, and BRAF V600E positivity are key indicators of poor CoM prognosis.
- BRAF V600E expression is linked to increased risk of metastasis and correlates with PD-1/PD-L1 expression, suggesting potential therapeutic targets.
