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Adjuvante Therapie und interdisziplinäre Nachsorge des Bindehautmelanoms

Adjuvant therapy and interdisciplinary follow-up care of conjunctival melanoma

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Zusammenfassung

Hintergrund

Maligne Melanome der Bindehaut neigen trotz mikroskopisch kontrollierter Exzision zur lokalen Rezidiventwicklung und lymphogenen sowie hämatogenen Metastasierung.

Fragestellung

Die Möglichkeiten der adjuvanten Therapie wie auch die Struktur einer interdisziplinären Nachsorge sollen für diese Patienten dargestellt werden.

Methoden

Der Beitrag bietet eine Literaturübersicht aus PUBMED und eigene klinische Ergebnisse.

Ergebnisse

Beim Bindehautmelanom sollte eine vollständige Tumorexzision in Minimal-touch-Technik immer kombiniert werden mit einer adjuvanten Therapie in Form von Kryo-, Radio-, topischer Chemo- und/oder Immuntherapie. Bei lokal umschriebenen Prozessen der bulbären Konjunktiva kann eine adjuvante Brachytherapie angeschlossen werden, bei nichtbulbärer, großflächiger, diffuser oder multilokulärer Ausdehnung eine adjuvante topische Mitomycin-C-Therapie oder Protonenbestrahlung. Neue adjuvante Ansätze umfassen die topische Interferon-α-2b-Immuntherapie, die topische Anti-VEGF-Therapie oder im Falle nachgewiesener BRAF-Mutationen die personalisierte Therapie mit selektiven BRAF- oder in Kombination mit MEK-Inhibitoren. Alle Patienten sollten in ein interdisziplinäres Nachsorgeprogramm eingebunden werden mit vierteljährlichen Kontrollen innerhalb der ersten 5 Jahre und dem Angebot einer psychoonkologischen Betreuung.

Schlussfolgerungen

Nach mikroskopisch kontrollierter Exzision sind die adjuvante Therapie in Form von Kryo-, Radio-, topischer Chemo- und/oder Immuntherapie wie auch die interdisziplinäre Nachsorge entscheidend in der modernen Betreuung von Patienten mit Bindehautmelanom.

Abstract

Background

Despite microscopically controlled tumor excision, malignant melanomas of the conjunctiva have a propensity for local recurrence, lymphatic spread and distant metastases.

Objectives

This review outlines the options of adjuvant therapy as well as the structure of interdisciplinary follow-up care for patients with conjunctival melanoma.

Methods

The study provides a PubMed literature review and own clinical results.

Results

In conjunctival melanoma complete tumor excision using a minimal touch technique should always be combined with adjuvant therapy, such as cryotherapy, radiotherapy, topical chemotherapy and/or immunotherapy. For locally circumscribed lesions of the bulbar conjunctiva adjuvant brachytherapy can be supplemented and for non-bulbar, extensive, diffuse or multilocular tumor growth, complementary adjuvant topical mitomycin C therapy or proton radiotherapy can be used. Novel adjuvant approaches include topical interferon alpha-2b immunotherapy, topical vascular endothelial growth factor (VEGF) inhibitors or in cases of BRAF mutations personalized therapy using selective BRAF inhibitors or in combination with mitogen-activated protein kinase (MAPK) and extracellular signal-regulated kinase (ERK), MAPK/ERK (MEK) inhibitors. All patients should be integrated into an interdisciplinary follow-up care program including quarter yearly checkups in the first 5 years and psycho-oncological healthcare.

Conclusion

Following microscopically controlled tumor excision, adjuvant treatment using cryotherapy, radiotherapy, topical chemotherapy and/or immunotherapy as well as interdisciplinary follow-up care are mandatory for the modern management of patients with conjunctival melanoma.

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Author information

Authors and Affiliations

  1. Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Straße 62, 50924, Köln, Deutschland

    L.M. Heindl, K.R. Koch & C. Cursiefen

  2. Centrum für Integrierte Onkologie (CIO) Köln-Bonn, Köln, Deutschland

    L.M. Heindl, M. Schlaak, C. Mauch & C. Cursiefen

  3. Klinik und Poliklinik für Dermatologie und Venerologie, Universität zu Köln, Köln, Deutschland

    M. Schlaak & C. Mauch

Authors
  1. L.M. Heindl
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  2. K.R. Koch
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  3. M. Schlaak
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  4. C. Mauch
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  5. C. Cursiefen
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Correspondence to L.M. Heindl.

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Interessenkonflikt

L.M. Heindl, K.R. Koch, M. Schlaak, C. Mauch und C. Cursiefen geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Additional information

Herrn Professor Dr. med. Dr. h.c. mult. G.O.H. Naumann, Emeritus der Augenklinik mit Poliklinik der Friedrich-Alexander-Universität Erlangen-Nürnberg, zum 80. Geburtstag gewidmet.

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Heindl, L., Koch, K., Schlaak, M. et al. Adjuvante Therapie und interdisziplinäre Nachsorge des Bindehautmelanoms. Ophthalmologe 112, 907–911 (2015). https://doi.org/10.1007/s00347-015-0141-4

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  • DOI: https://doi.org/10.1007/s00347-015-0141-4

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