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Melanoma: HELP
Articles by Bertil E. Damato
Based on 94 articles published since 2008
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Between 2008 and 2019, B. Damato wrote the following 94 articles about Melanoma.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Guideline Uveal Melanoma UK National Guidelines. 2015

Nathan, P / Cohen, V / Coupland, S / Curtis, K / Damato, B / Evans, J / Fenwick, S / Kirkpatrick, L / Li, O / Marshall, E / McGuirk, K / Ottensmeier, C / Pearce, N / Salvi, S / Stedman, B / Szlosarek, P / Turnbull, N / Anonymous4090839. ·Mount Vernon Cancer Centre, Northwood, Middlesex, UK. Electronic address: nathan.pd@gmail.com. · Ocular Oncology Service, St Bartholomew's and Moorfields Eye Hospital, London, UK. · Department Molecular and Clinical Cancer Medicine, University of Liverpool, UK. · OcuMel UK, UK. · Royal Liverpool University Hospital, Liverpool, UK. · University Hospital Aintree, Liverpool, UK. · Patient Representative, UK. · Moorfields Eye Hospital, London, UK. · The Clatterbridge Cancer Centre, NHS Foundation Trust, Liverpool, UK. · Southampton University Hospitals and University of Southampton, UK. · University Hospital Southampton, Southampton, UK. · Royal Hallamshire Hospital, Sheffield, UK. · Southampton University Hospitals, NHS Trust, Southampton, UK. · St Bartholomew's Hospital, UK; Barts Cancer Institute, Queen Mary University of London, London, UK. · Project Manager, London, UK. ·Eur J Cancer · Pubmed #26278648.

ABSTRACT: The United Kingdom (UK) uveal melanoma guideline development group used an evidence based systematic approach (Scottish Intercollegiate Guidelines Network (SIGN)) to make recommendations in key areas of uncertainty in the field including: the use and effectiveness of new technologies for prognostication, the appropriate pathway for the surveillance of patients following treatment for primary uveal melanoma, the use and effectiveness of new technologies in the treatment of hepatic recurrence and the use of systemic treatments. The guidelines were sent for international peer review and have been accredited by NICE. A summary of key recommendations is presented. The full documents are available on the Melanoma Focus website.

2 Editorial Managing patients with ocular melanoma: state of the art. 2008

Damato, Bertil / Coupland, Sarah E. · ·Clin Exp Ophthalmol · Pubmed #18983541.

ABSTRACT: -- No abstract --

3 Editorial Choroidal melanoma endoresection, dandelions and allegory-based medicine. 2008

Damato, Bertil. · ·Br J Ophthalmol · Pubmed #18653590.

ABSTRACT: -- No abstract --

4 Review Ocular treatment of choroidal melanoma in relation to the prevention of metastatic death - A personal view. 2018

Damato, Bertil. ·Ocular Oncology Service, Department of Ophthalmology, University of California San Francisco, 10 Koret Way, San Francisco, CA 94143, USA. Electronic address: Bertil.Damato@UCSF.edu. ·Prog Retin Eye Res · Pubmed #29571968.

ABSTRACT: About 50% of patients with choroidal melanoma develop metastatic disease, despite successful eradication of the primary tumor. Patient care is complicated by the fact that we do not know whether ocular treatment ever influences survival and if so in whom. Some authorities believe that metastatic spread is never preventable, because it has always occurred by the time the ocular tumor is detected. Others hold the view that metastatic spread can occur late, at least in some patients, in whom timely and successful treatment is life-saving. Some melanomas never seem to metastasize, even if they reach an advanced stage. It is likely that many patients are undergoing futile enucleation or experiencing severe ocular morbidity and visual loss from excessive radiation safety margins in the hope of living longer. Some of these patients would do better with tumor resection, often rejected because of concerns about iatrogenic tumor dissemination. At the same time, many patients with a small melanoma are being left untreated for years until growth is documented, possibly missing opportunities for prolonging life. Metastatic disease is highly likely when genetic tumor analysis detects monosomy 3, chromosome 8q gain, a class 2 gene expression profile, and/or BAP1 loss. Do these lethal genetic aberrations ever develop while the patient is under observation? If so, can these be predicted by genetic analysis? Do lethal mutations and metastasis ever occur because ocular treatment has failed to eradicate the tumor completely? Answers to these questions would profoundly change the management of patients with uveal melanoma.

5 Review Uveal Melanoma Treatment and Prognostication. 2017

Dogrusöz, Mehmet / Jager, Martine J / Damato, Bertil. ·Department of Ophthalmology, LUMC, Leiden, The Netherlands. · Departments of Ophthalmology and Radiation Oncology, University of California, San Francisco, California, United States. ·Asia Pac J Ophthalmol (Phila) · Pubmed #28399342.

ABSTRACT: Approximately 90% of uveal melanoma develop in the choroid, with the remainder arising in the ciliary body or the iris. The treatment of uveal melanoma is aimed at conserving the eye and useful vision, and, if possible, preventing metastatic disease. Enucleation is now reserved for tumors that are large and/or involve the optic disc, having largely been replaced by various forms of radiotherapy (plaque brachy-therapy, proton beam or stereotactic radiotherapy) and laser therapy. Whereas iridectomy and iridocyclectomy are widely performed, transscleral exoresection of choroidal tumors is performed only in a few centers because it requires special skills and hypotensive anesthesia. Transretinal endoresection using vitrectomy equipment is easier but controversial because of concerns about tumor seeding. Long-term postoperative surveillance is necessary to identify and treat local tumor recurrence and any other complications, such as radiation-induced morbidity, and to provide counseling to the patient. Factors predicting metastasis include older age, large tumor size, ciliary body involvement, extraocular spread, epithelioid cytomorphology, chromosome 3 loss and chromosome 8q gain, class 2 gene expression profile, loss of BRCA1-associated protein-1 (BAP1), and the presence of inflammation. Prognostication is enhanced by multi-variable analysis combining clinical, histologic, and genetic factors, also taking the patient's age and sex into account. As there is a lack of options for treating metastases, much research is focused on identifying potential therapeutic targets.

6 Review Management of Primary Acquired Melanosis, Nevus, and Conjunctival Melanoma. 2016

Kao, Andrew / Afshar, Armin / Bloomer, Michele / Damato, Bertil. ·Department of Ophthalmology, University of California, San Francisco, CA 94143, USA. Bertil.Damato@ucsf.edu. ·Cancer Control · Pubmed #27218788.

ABSTRACT: BACKGROUND: The management of conjunctival melanoma is difficult because of the rarity of the disease, confusing terminology, high rates of local tumor recurrence, controversies regarding treatment, a poor evidence base, unreliable prognostication, and significant mortality rates. METHODS: The medical literature was reviewed, focusing on treatment and management options for conjunctival melanoma. Recent trends and developments were summarized with respect to terminology, local treatment, histology, genetic analysis, prognostication, and systemic treatment, highlighting the scope for research and possible improvements in patient care. RESULTS: Histopathological diagnostic terminology for primary acquired melanosis is being superseded by more explicit terminology, thus differentiating hypermelanosis from conjunctival melanocytic intraepithelial neoplasia. Topical chemotherapy and increased use of adjunctive radiotherapy have helped improve rates of local tumor control. Use of exenteration has become rare. Regional and systemic metastases are common in patients with nonbulbar conjunctival melanoma, although long-term survivors with metastases are growing in number. Prognostication is mainly based on tumor size and location, but histological and genetic data into multivariate analyses will soon be incorporated. The role of sentinel lymph-node biopsy continues to be controversial. Chemotherapy for metastatic disease is being superseded by targeted therapy based on genetic abnormalities such as BRAF mutations. CONCLUSIONS: The management of conjunctival melanoma requires expert care from an experienced, multidisciplinary team. The goal of therapy is to provide good local tumor control with minimal morbidity, high-quality pathology, and adequate psychological support. Maximizing patient enrollment in multicenter clinical trials is likely to strengthen evidence-based decision-making.

7 Review Uveal melanoma: evidence for efficacy of therapy. 2015

Afshar, Armin R / Damato, Bertil E. · ·Int Ophthalmol Clin · Pubmed #25436491.

ABSTRACT: -- No abstract --

8 Review Intraocular collision tumour: case report and literature review. 2013

Coupland, Sarah E / Dodson, Andrew / Liu, Hongxiang / Du, Ming-Qing / Angi, Martina / Damato, Bertil E. ·Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 5th Floor Duncan Building, Daulby Street, Liverpool, L69 3GA, UK. s.e.coupland@liverpool.ac.uk ·Graefes Arch Clin Exp Ophthalmol · Pubmed #23232651.

ABSTRACT: BACKGROUND: "Collision" tumours consist of different neoplasms coexisting within a single lesion. Whilst quite common in the skin, the gastrointestional tract, and the ovaries, intraocular collision tumours are exceedingly rare. We describe an exceptional case of a combined uveal melanoma and intraocular plasmacytoma. METHODS: Observational case report. A 61-year-old woman underwent enucleation for rubeotic glaucoma and cells in the anterior chamber after proton-beam radiotherapy of a cilio-choroidal melanoma of the right eye. Examination of the enucleated eye was performed with immunohistochemistry, multiplex ligation dependent probe amplification (MLPA), and polymerase chain reaction (PCR) for immunoglobulin heavy- and light-chain gene rearrangements. A review of the literature on ocular collision tumours and uveal involvement by plasma cell neoplasms was also performed. RESULTS: Morphological, immunophenotypical, and genotypical examination of the tumour revealed the co-existence of both a melanoma and a plasmacytoma within the choroid and ciliary body. The glaucoma was caused by extensive infiltration of the iris and trabecular meshwork by the plasmacytoma cells. Review of the literature revealed only four collision tumours involving the eyelid and three involving the choroid. All three intraocular collision tumours consisted of uveal melanoma and choroidal non-Hodgkin lymphoma. Uveal involvement by plasma cell neoplasms is also extremely rare, with only six reported cases. CONCLUSIONS: This is the first documented intraocular collision tumour consisting of a uveal melanoma and isolated plasmacytoma. If a patient presents with 'uveitis' after proton-beam radiotherapy of a cilio-choroidal melanoma, there may be scope for performing biopsies to determine whether the lymphoid infiltrate is reactive or neoplastic.

9 Review Conjunctival melanoma and melanocytic intra-epithelial neoplasia. 2013

Kenawy, N / Lake, S L / Coupland, S E / Damato, B E. ·St Paul's Eye Unit, Liverpool Ocular Oncology Service, Royal Liverpool University Hospital, Liverpool, UK. nkenawy@liv.ac.uk ·Eye (Lond) · Pubmed #23222568.

ABSTRACT: The rarity of conjunctival melanoma has impeded progress in the management of patients with this cancer; however, much progress has occurred in recent years. Primary acquired melanosis is now differentiated histologically into hypermelanosis and conjunctival melanocytic intra-epithelial neoplasia, for which an objective reproducible scoring system has been developed. Mapping and clinical staging of conjunctival disease has improved. Adjunctive radiotherapy and topical chemotherapy have made tumour control more successful, with reduced morbidity. Genetic analyses have identified BRAF and other mutations, which may predict responsiveness to new chemotherapeutic agents, for example Vemurafenib, should metastatic disease develop. Multicentre studies are under way to enhance survival prediction by integrating clinical stage of disease with histological grade of malignancy and genetic abnormalities. Such improved prognostication would not only be more relevant to individual patients, but would also provide greater opportunities for basic science research.

10 Review Molecular pathology of uveal melanoma. 2013

Coupland, S E / Lake, S L / Zeschnigk, M / Damato, B E. ·Pathology, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK. s.e.coupland@liverpool.ac.uk ·Eye (Lond) · Pubmed #23222563.

ABSTRACT: Like other cancers, uveal melanomas (UM) are characterised by an uncontrolled, clonal, cellular proliferation, occurring as a result of numerous genetic, and epigenetic aberrations. Signalling pathways known to be disrupted in UM include: (1) the retinoblastoma pathway, probably as a result of cyclin D1 overexpression; p53 signalling, possibly as a consequence of MDM2 overexpression; and the P13K/AKT and mitogen-activated protein kinase/extracellular signal-related kinase pathway pathways that are disturbed as a result of PTEN and GNAQ/11 mutations, respectively. Characteristic chromosomal abnormalities are common and include 6p gain, associated with a good prognosis, as well as 1p loss, 3 loss, and 8q gain, which correlate with high mortality. These are identified by techniques such as fluorescence in situ hybridisation, comparative genomic hybridisation, microsatellite analysis, multiplex ligation-dependent probe amplification, and single-nucleotide polymorphisms. UM can also be categorised by their gene expression profiles as class 1 or class 2, the latter correlating with poor survival, as do BRCA1-associated protein-1 (BAP1) inactivating mutations. Genetic testing of UM has enhanced prognostication, especially when results are integrated with histological and clinical data. The identification of abnormal signalling pathways, genes and proteins in UM opens the way for target-based therapies, improving prospects for conserving vision and prolonging life.

11 Review Effects of radiotherapy on uveal melanomas and adjacent tissues. 2013

Groenewald, C / Konstantinidis, L / Damato, B. ·Ocular Oncology Service, St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK. ·Eye (Lond) · Pubmed #23196647.

ABSTRACT: Most uveal melanomas are treated with radiotherapy. An adequate understanding of the effects of radiation on the tumour and the healthy ocular tissues is necessary. Ionizing radiation damages cell membranes, organelles, and DNA. Irradiated cells are lysed or undergo apoptosis, necrosis, and senescence. These effects occur in tumour cells and vascular endothelial cells, resulting in tumour shrinkage, ischaemia, infarction, exudation, and fibrosis, which can cause exudative maculopathy, serous retinal detachment, rubeosis, and neovascular glaucoma (ie, 'toxic tumour syndrome'). Such abnormalities must be distinguished from collateral damage to healthy ocular tissues that receive high doses of radiation, and these include radiation-induced retinopathy, optic neuropathy, choroidopathy, cataract, and scleral necrosis. Radiation retinopathy can be treated effectively with photodynamic therapy, anti-angiogenic agents, and intravitreal steroid injections. In some patients, optic neuropathy may improve with intravitreal steroids or anti-angiogenic agents. Neovascular glaucoma resolves with intra-cameral bevacizumab. Exudative retinal detachment can regress with intra-vitreal steroid injections. Cataract is treated in the usual manner. Scleral necrosis, if severe, may require grafting, possibly using a lamellar flap from the same eye. Depending on the bulk of the residual toxic tumour, treatment can consist of intra-vitreal steroids and/or anti-angiogenic agents, transpupillary thermotherapy or photodynamic therapy to the tumour, or surgical removal of the tumour by endo- or exo-resection. Measures aimed at preventing collateral damage include eccentric placement of ruthenium plaques or iodine seeds and delivery of a notched proton beam. The decision to treat a uveal melanoma with radiotherapy requires the ability to manage iatrogenic side effects and complications.

12 Review Personalized treatment of uveal melanoma. 2013

Damato, B / Heimann, H. ·Department of Molecular and Clinical Cancer Medicine, Ocular Oncology Service, Royal Liverpool University Hospital, Liverpool, UK. Bertil@Damato.co.uk ·Eye (Lond) · Pubmed #23174751.

ABSTRACT: Personalized treatment of uveal melanoma involves the tailoring of all aspects of care to the condition, needs, wishes, and fears of the patient, taking account of the individual's circumstances. When selecting between radiotherapy, surgical resection, and phototherapy, or when deciding how best to combine these different therapeutic modalities, it is necessary to understand the patients utilities, with respect to tumour control, visual conservation, and preservation of the eye, so as to prioritize outcomes accordingly. For example, such considerations would influence the width of the safety margins when administering radiotherapy, according to whether the patient considers it more important to conserve vision or to guarantee tumour control. With 'suspicious naevi', the choice between observation, immediate treatment, and biopsy is complicated by the lack of adequate survival data on which to base rational decisions, making it necessary for both patient and doctor to accept uncertainty. Personalized care should involve close relatives, as appropriate. It must also adapt to changes in the patient's needs over time. Such personalized care demands the ability to respond to such needs and the sensitivity to identify these requirements in the first place. Personalized treatment enhances not only the patient's satisfaction but also the 'job satisfaction' of all members of the multidisciplinary team, improving quality of care.

13 Review Local resection of uveal melanoma. 2012

Damato, Bertil E. ·Royal Liverpool University Hospital, Liverpool, UK. bertil@damato.co.uk ·Dev Ophthalmol · Pubmed #22042014.

ABSTRACT: Local resection of uveal melanoma is aimed at conserving the eye and useful vision while removing any threat of metastatic spread. The tumour can be removed en bloc through a scleral opening (i.e., 'exoresection') or in a piecemeal fashion with a vitreous cutter passed through the retina (i.e., 'endoresection'). Variations of exoresection include iridectomy, iridocyclectomy, cyclochoroidectomy, and choroidectomy. Endoresection can be performed through a retinotomy or under a large retinal flap. Both exoresection and endoresection can be undertaken as a primary procedure, or after other conservative therapy as treatment for recurrent or toxic tumour. Each can be performed in combination with some form of radiotherapy, which can precede or follow the surgical resection. Endoresection should be relatively straightforward for experienced vitreoretinal surgeons; however, exoresection is more challenging, particularly with large and posterior tumours, because of the need for hypotensive anaesthesia and other measures to control intra-operative haemorrhage. In addition to their technical complexities, exoresection and endoresection are limited by intuitive concerns regarding iatrogenic tumour dissemination. When these obstacles are overcome, local resection preserves eyes that would otherwise be inoperable and produces relatively large tumour samples, which are useful for prognostication and research and which may one day have therapeutic value.

14 Review Treatment selection for uveal melanoma. 2012

Damato, Bertil E. ·Ocular Oncology Service, Royal Liverpool University Hospital, Liverpool, UK. bertil@damato.co.uk ·Dev Ophthalmol · Pubmed #22042010.

ABSTRACT: Uveal melanomas can be treated by various forms and combinations of radiotherapy, phototherapy and local resection, which need to be tailored to the tumour size, location and extent as well as the patient's needs, fears and wishes. Many factors complicate the process of treatment selection and these include limited resources, incomplete knowledge of the patient's condition (e.g. genetic tumour type) and inadequate scientific evidence on which to base decision making. In this chapter, I describe how I select treatment for small, large, juxtapapillary, ciliary and iridal melanomas, respectively, and for melanocytic tumours of indeterminate malignancy. I also describe how I interact with patients so as to select the most suitable treatment in a personalised manner. Finally, I discuss challenges and shortcomings in this aspect of patient care, also providing suggestions for further research in this field.

15 Review Estimating prognosis for survival after treatment of choroidal melanoma. 2011

Damato, Bertil / Eleuteri, Antonio / Taktak, Azzam F G / Coupland, Sarah E. ·Ocular Oncology Service, Royal Liverpool University Hospital, Prescot St, Liverpool L7 8XP, UK. Bertil@damato.co.uk ·Prog Retin Eye Res · Pubmed #21658465.

ABSTRACT: Choroidal melanoma is fatal in about 50% of patients. This is because of metastatic disease, which usually involves the liver. Kaplan-Meier survival curves based only on tumor size and extent do not give a true indication of prognosis. This is because the survival prognosis of choroidal melanoma correlates not only with clinical stage but also with histologic grade, genetic type, and competing causes of death. We have developed an online tool that predicts survival using all these data also taking normal life-expectancy into account. The estimated prognosis is accurate enough to be relevant to individual patients. Such personalized prognostication improves the well-being of patients having an excellent survival probability, not least because it spares them from unnecessary screening tests. Such screening can be targeted at high-risk patients, so that metastases are detected sooner, thereby enhancing any opportunities for treatment. Concerns about psychological harm have proved exaggerated. At least in Britain, patients want to know their prognosis, even if this is poor. The ability to select patients with a high risk of metastasis improves prospects for randomised studies evaluating systemic adjuvant therapy aimed at preventing or delaying metastatic disease. Furthermore, categorization of tissue samples according to survival prognosis enables laboratory studies to be undertaken without waiting many years for survival to be measured. As a result of advances in histologic and genetic studies, biopsy techniques and statistics, prognostication has become established as a routine procedure in our clinical practice, thereby enhancing the care of patients with uveal melanoma.

16 Review Does ocular treatment of uveal melanoma influence survival? 2010

Damato, B. ·Ocular Oncology Service, Royal Liverpool University Hospital, Prescot St, Liverpool L7 8XP, UK. Bertil@Damato.co.uk ·Br J Cancer · Pubmed #20661247.

ABSTRACT: Treatment of uveal (intraocular) melanoma is aimed at prolonging life, if possible conserving the eye and useful vision. About 50% of patients develop fatal metastatic disease despite successful eradication of the primary intraocular tumour. The effect of ocular treatment on survival is unknown, because the same survival data from case series can be interpreted in different ways. Treatment is therefore based on intuition and varies greatly between centres. Randomised trials of treatment vs non-treatment of asymptomatic tumours are desirable but would be controversial, difficult, expensive and possibly inconclusive. Strategies for coping with uncertainty are needed to avoid unethical care.

17 Clinical Trial Concordant chromosome 3 results in paired choroidal melanoma biopsies and subsequent tumour resection specimens. 2015

Coupland, Sarah E / Kalirai, Helen / Ho, Vivian / Thornton, Sophie / Damato, Bertil E / Heimann, Heinrich. ·Department of Pathology, Royal Liverpool and Broadgreen University Hospital Trust (RLBUHT), University of Liverpool, Liverpool, UK. · Department of Ophthalmology, Royal Liverpool and Broadgreen University Hospital Trust (RLBUHT), Liverpool, UK. · Department of Ophthalmology, Royal Liverpool and Broadgreen University Hospital Trust (RLBUHT), Liverpool, UK Ocular Oncology Service, University of California, San Francisco, California, USA. ·Br J Ophthalmol · Pubmed #26206786.

ABSTRACT: BACKGROUND/AIM: The study's aim was to compare chromosome 3 aberrations of choroidal melanoma (CM) as determined by multiplex ligation dependent probe amplification (MLPA) or microsatellite analysis (MSA) in intraocular tumour biopsies with those results obtained from subsequent endoresection/enucleation of the same CM. METHODS: A retrospective cohort of 28 patients with CM seen between 2007 and 2014 at the Liverpool Ocular Oncology Centre was analysed. Prognostic genetic testing, for chromosome 3 status, was performed on all tumour specimens, either by MLPA or MSA, depending on DNA yield. In nine cases genetic testing was performed on a sample taken after radiotherapy; four of these had genetic information pre- and post-radiotherapy. RESULTS: Fourteen biopsy specimens were analysed by MLPA and 14 by MSA. Twenty-seven endoresection or enucleation specimens were analysed by MLPA, and a single enucleation specimen by MSA. Chromosome 3 data showed prognostic concordance for the patient-matched samples in all 28 cases including 4 cases where samples were taken pre pre- and post radiotherapy. Thirteen cases were classified as monosomy 3 and 12 as disomy 3. Two cases had a loss of chromosome arm 3q in both samples and a single case showed loss of 3p in the biopsy sample with complete monosomy 3 in the subsequent enucleation sample taken 5 months later. CONCLUSIONS: Intraocular biopsy of CM yields similar prognostic information to larger surgical specimens. Initial evidence, that genetic testing can be successfully conducted post radiotherapy, is also provided. TRIAL REGISTRATION NUMBER: NITRO trial, ISRCTN35236442.

18 Article Clinical evaluation of a paper chart for predicting ruthenium plaque placement in relation to choroidal melanoma. 2018

Rospond-Kubiak, I / Kociecki, J / Damato, B. ·Ocular Oncology Service, Department of Ophthalmology, Poznań University of Medical Sciences, Poznań, Poland. · Ocular Oncology Service, Department of Ophthalmology, University of California, San Francisco, CA, USA. · Department of Radiation Oncology, University of California, San Francisco, CA, USA. ·Eye (Lond) · Pubmed #28960216.

ABSTRACT: PurposeTo determine the accuracy of estimated tumour location and required plaque position using fundus diagrams, and to evaluate their applicability in daily clinical practice.Patients and methodsBetween September 2013 and March 2016, all patients treated with ruthenium plaque brachytherapy for choroidal melanoma at the Department of Ophthalmology in Poznań underwent pretreatment planning with the use of printed or electronic fundus diagrams www.oculonco.comThe estimated distances were then verified intraoperatively.ResultsThere were 40 eyes of 40 patients: 15 men, 25 women, with a median age of 61 years (range: 21-88). The median longitudinal basal diameter (LBD) of the treated melanomas was 10.4 mm (range: 6.5-14.9) and the median thickness was 4.1 mm (range: 1.9-6). The final postition of the anterior tumour margin was within 1 mm of the estimated location in 39 cases (97 %), and within 2 mm in 1 case (3 %). Median follow-up was 15 months (range: 3-36). By the close of the study, there was one local tumour recurrence (3%) and one patient died of unrelated cause 1 year after treatment. No patient developed metastases by study close.ConclusionsThe plaque planning system using the paper fundus diagrams proved to be accurate, easily applicable and should aid plaque placement where computer modelling is not possible.

19 Article Photodynamic therapy as initial treatment for small choroidal melanomas. 2017

Jmor, F / Hussain, R N / Damato, B E / Heimann, H. ·Liverpool Ocular Oncology Clinic, St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK. Electronic address: fidanjmor@hotmail.com. · Liverpool Ocular Oncology Clinic, St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK. · Liverpool Ocular Oncology Clinic, St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK; Ocular Oncology Service, University of California, San Francisco, USA. ·Photodiagnosis Photodyn Ther · Pubmed #29074262.

ABSTRACT: PURPOSE: To evaluate Verteporfin photodynamic therapy (PDT) as primary treatment for small, posterior choroidal melanoma. DESIGN: Retrospective cohort review. SUBJECTS, PARTICIPANTS AND CONTROLS: Retrospective case note review of 20 patients with small juxtapapillary and juxtafoveal choroidal melanomas treated with PDT at the Liverpool Ocular Oncology Clinic. METHODS: Patient and tumour characteristics, PDT session details, visual acuity and B-scan ultrasonography measurements as well as colour fundus photographs at each examination were collated and analysed. MAIN OUTCOME MEASURES: Local tumour control and Best Corrected Visual Acuity (BCVA). RESULTS: The 20 patients (14 male, 6 female) had a mean age of 61.2 years (range, 40-85) and were treated between 2001 and 2012. Seven tumours were amelanotic, while 13 were pigmented. Of 20 melanomas, 11 (55%) showed complete regression on B-scan ultrasonography and colour photography; five (25%) showed partial regression; four (20%) remained unchanged and two (10%) showed further growth, for which alternative standard treatment was required. Baseline BCVA was 0.1 logMAR (mean; range 0.0-0.6) compared to a post-PDT BCVA of 0.4 logMAR (mean; range -0.2 to 1.7) over a follow-up of 60.0 months (mean; range 25-156 months). CONCLUSIONS: PDT can induce tumour regression in a significant proportion of small, posterior, choroidal melanomas but is less reliable than other forms of therapy. It may have a role in patients with special visual requirements if they accept the increased risk of treatment failure requiring radiotherapy.

20 Article Prognostic biopsy of choroidal melanoma: an optimised surgical and laboratory approach. 2017

Angi, Martina / Kalirai, Helen / Taktak, Azzam / Hussain, Rumana / Groenewald, Carl / Damato, Bertil E / Heimann, Heinrich / Coupland, Sarah E. ·Department of Clinical and Molecular Cancer Medicine, Liverpool Ocular Oncology Research Group, University of Liverpool, Liverpool, UK. · Liverpool Ocular Oncology Centre, St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK. · Department of Medical Physics & Clinical Engineering, Royal Liverpool University Hospital, Liverpool, UK. · Department of Ophthalmology and Radiation Oncology, Ocular Oncology Service, University of California, San Francisco, California, USA. · Department of Cellular Pathology, Royal Liverpool University Hospital, Liverpool, UK. ·Br J Ophthalmol · Pubmed #28596284.

ABSTRACT: BACKGROUND: Accurate survival prognostication for patients with uveal melanoma (UM) enables effective patient counselling and permits personalised systemic surveillance for the early detection of metastases and, in high-risk patients, enrolment in any trials of systemic adjuvant therapy. The aim of this work is to determine the success of prognostic UM tumour biopsy using an improved surgical approach and optimised sample handling workflow. METHODS: Patients with UM treated by primary radiotherapy between 2011 and 2013 and who underwent a prognostic biopsy with cytology, multiplex ligation-dependent probe amplification and/or microsatellite analysis were included. The main outcomes and measures were success of cytology and genetic studies, and surgical complications. RESULTS: The cohort comprised 232 patients with UM having a median age of 59 years (range, 25-82) at treatment. The median largest basal diameter was 11.4 mm (range, 4.1-20.8) and tumour height was 3.4 mm (range, 0.7-10.3). Ciliary body involvement was noted in 42 cases. Treatment consisted of Ru-106 brachytherapy in 151 cases (65%) and proton beam radiotherapy in 81 cases (35%). With improvements in surgical techniques and laboratory methods over time, cytology success increased from 92% (131/142) to 99% (89/90) and the numbers of samples with sufficient DNA for genetic testing increased from 79% (104/131) to 93% (83/89). Overall, chromosome 3 loss was noted in 64/187 (34%) cases. Surgical complications, including transient localised bleeding, vitreous haemorrhage and retinal perforation, decreased over time. Eight patients required additional surgery. CONCLUSIONS: Improved surgical techniques and laboratory methods yielded successful cytology and genetic information in the majority of cases. PRECIS: Analysis of data from 232 patients with uveal melanoma undergoing prognostic tumour biopsy demonstrated that improved surgical techniques and laboratory methods yielded successful cytology and genetic information in 99% and 89% of cases, respectively.

21 Article Incorporating Clinical, Histological, and Genetic Parameters for Choroidal Melanoma Prognostication. 2017

Coupland, Sarah E / Taktak, Azzam / Damato, Bertil. ·Department of Cellular and Molecular Pathology, University of Liverpool, Liverpool, England. · Royal Liverpool University Hospital, Liverpool, England. · Ocular Oncology Service, University of California-San Francisco, San Francisco. ·JAMA Ophthalmol · Pubmed #28542696.

ABSTRACT: -- No abstract --

22 Article Porous Versus Nonporous Orbital Implants After Enucleation for Uveal Melanoma: A Randomized Study. 2017

Ho, Vivian W M / Hussain, Rumana N / Czanner, Gabriela / Sen, Julia / Heimann, Heinrich / Damato, Bertil E. ·*Liverpool Ocular Oncology Centre, Royal Liverpool University Hospital, Liverpool, United Kingdom; †Department of Biostatistics and Department of Eye and Vision Science, University of Liverpool, Liverpool, United Kingdom; ‡Ophthalmology Department, Alexandra Hospital, Worcestershire Acute NHS Trust, Redditch, United Kingdom; and §Ocular Oncology Service, University of California, San Francisco, California, U.S.A. ·Ophthalmic Plast Reconstr Surg · Pubmed #27861329.

ABSTRACT: PURPOSE: To compare hydroxyapatite with acrylic implants after enucleation for uveal melanoma with respect to eyelid position, ocular motility, implant complications, and patient satisfaction. METHODS: Patients undergoing primary enucleation for uveal melanoma between May 2005 and November 2012 at the Liverpool Ocular Oncology Centre, United Kingdom, were randomized between hydroxyapatite and acrylic implants. Questionnaires were sent to patients and ocularists to comment on the main outcomes. RESULTS: A total of 416 patients were recruited in the study, of whom 281 were included, with 49.5% (139/281) and 50.5% (142/281) receiving a hydroxyapatite (HA) or acrylic (AC) implant. Mailed questionnaires completed at ≥18 months by patients showed no significant differences between the groups in eyelid position, prosthetic motility, socket complications, and patient satisfaction. Complications included implant extrusion (1% vs 4%), enophthalmos (26% vs 26%), and superior sulcus deformity (24% vs 24%) with HA and AC implants, respectively, (Fisher exact test p > 0.0125 in all, Bonferroni correction). Questionnaires completed by ocularists indicated no significant differences in eyelid opening, prosthetic motility, and other complications at 6 months (Fisher exact test, p > 0.05 in all); there was a higher prevalence of ptosis with AC than HA implants (46% vs 25%, p = 0.03) and a greater need for ocularists' treatment with HA than AC (50% vs 28%, p = 0.03). CONCLUSIONS: Patient-reported outcomes after enucleation for uveal melanoma indicate no major differences between hydroxyapatite and acrylic implants in surgical outcomes and patient satisfaction. There was a higher prevalence of ptosis with AC and a greater need of ocularists' visits with HA at around 6 months observed by ocularists.

23 Article External Validation of the Liverpool Uveal Melanoma Prognosticator Online. 2016

DeParis, Sarah W / Taktak, Azzam / Eleuteri, Antonio / Enanoria, Wayne / Heimann, Heinrich / Coupland, Sarah E / Damato, Bertil. ·Department of Ophthalmology, University of California-San Francisco, San Francisco, California, United States. · Department of Medical Physics and Clinical Engineering, Royal Liverpool University Hospital, Liverpool, United Kingdom. · Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, United States. · Liverpool Ocular Oncology Service, Royal Liverpool University Hospital, Liverpool, United Kingdom. · Pathology, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom. · Department of Ophthalmology, University of California-San Francisco, San Francisco, California, United States 4Liverpool Ocular Oncology Service, Royal Liverpool University Hospital, Liverpool, United Kingdom. ·Invest Ophthalmol Vis Sci · Pubmed #27835710.

ABSTRACT: Purpose: To validate the Liverpool Uveal Melanoma Prognosticator Online (LUMPO) in a cohort of patients treated at the University of California-San Francisco (UCSF). Methods: A retrospective chart review was performed of 390 patients treated between 2002 and 2007 for choroidal melanoma at UCSF. Similar patients (n = 1175) treated at the Liverpool Ocular Oncology Centre (LOOC) were included in the study. The data were analyzed using the model previously developed for LUMPO, an online prognostication tool combining multiple prognostic factors. Main outcome measures included all-cause mortality and melanoma-specific mortality. Reliability of the survival estimates in each group of patients was indicated by the C-indices of discrimination and Hosmer-Lemeshow test. Results: Patients treated at UCSF tended to be younger with thicker tumors, and were more likely to receive proton beam radiotherapy as primary treatment compared to patients at LOOC. There were no significance differences with respect to ciliary body involvement, melanoma cytomorphology, and mitotic counts between the two groups. Death occurred in 140/390 (35%) patients from UCSF and 409/1175 (34%) patients from LOOC, with no difference in overall mortality by Kaplan-Meier analysis (log rank test, P = 0.503). For all-cause mortality and melanoma-specific mortality, the C-index of discrimination and Hosmer-Lemeshow test at 5 years after treatment indicated good discrimination performance of the model, with no statistically significant difference between observed and predicted survival. Conclusions: Despite differences between the two cohorts, external validation in patients treated at UCSF indicates that LUMPO estimated the all-cause and melanoma-specific mortality well.

24 Article Two-year patient-reported outcomes following treatment of uveal melanoma. 2016

Hope-Stone, L / Brown, S L / Heimann, H / Damato, B / Salmon, P. ·Institute of Psychology, Health & Society, University of Liverpool, Liverpool, UK. · Liverpool Ocular Oncology Centre, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK. · Ocular Oncology Service, University of California, San Francisco, CA, USA. ·Eye (Lond) · Pubmed #27589051.

ABSTRACT: PurposeTreatment of uveal melanoma can impair patients' psychological well-being. We evaluated patient-reported outcome measures (PROMs) of anxiety, depression, and quality of life (QoL) over 2 years following treatment in a consecutive sample of uveal melanoma patients, compared observations to population normative values and examined whether outcomes differed according to patients' age, gender, and whether or not they were treated by enucleation or had a poor prognosis (presence of monosomy 3).DesignProspective longitudinal study.ParticipantsPatients (N=411) with uveal melanoma treated between 2008 and 2011.MethodsSelf-report questionnaire study. We compared mean PROMs scores obtained 6 months, 1 year, and 2 years after treatment to published population normative values using 2-sample t-tests, and tested the association of these scores with gender, age, treatment by enucleation, and monosomy 3 using mixed-model ANOVAs.ResultsOn QoL and depression, patients were similar to or better than normative values at all time points, but there was some evidence that females were more anxious than female normative values (Ps<0.001-<0.05). Younger patients (P<0.01) and female patients (P<0.01) were the most anxious overall. Enucleation was not associated with PROMs. Patients with monosomy 3 showed more depressed mood at all the three time points (P<0.05).ConclusionsPatients treated for uveal melanoma can expect, within 6 months of treatment, to have a QoL that is similar to that of the general population. Younger female patients and patients with monosomy 3 are more likely to be distressed, and clinicians will need to be alert to this.

25 Article Prognostic Biopsy of Choroidal Melanoma after Proton Beam Radiation Therapy. 2016

Hussain, Rumana N / Kalirai, Helen / Groenewald, Carl / Kacperek, Andrzej / Errington, R Douglas / Coupland, Sarah Ellen / Heimann, Heinrich / Damato, Bertil. ·Liverpool Ocular Oncology Service, St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK. · Liverpool Ocular Oncology Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK. · Department of Clinical Oncology, Clatterbridge Cancer Center, Bebington, Wirral, UK. · Liverpool Ocular Oncology Research Group, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK. Electronic address: s.e.coupland@liverpool.ac.uk. · Liverpool Ocular Oncology Service, St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK; Ocular Oncology Service, Departments of Ophthalmology and Radiation Oncology, University of California, San Francisco, California. ·Ophthalmology · Pubmed #27324683.

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