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Conjunctival malignant melanoma is a pigmented lesion of the ocular surface. It is an uncommon but potentially devastating tumor that may invade the local tissues of the eye, spread systemically through lymphatic drainage and hematogenous spread, and recur in spite of treatment. Despite its severity, the rarity of available cases has limited the evidence for diagnosis and management. This review will provide an overview of the epidemiology, risk factors, presentation, diagnosis, management, prognosis, staging, and surveillance of conjunctival melanoma, with an emphasis on recent advances in biological therapies to treat this disease.

Background: Ocular malignancies are uncommon among eye diseases; however, they jeopardize both vision and life. The main objective of this study was to use to describe the epidemiology of eye and ocular adnexa malignancies across different ages and sex. Methods: The King Khaled University institutional review board approved this study. Data on ocular cancer were retrieved from the Saudi Cancer Registry between 1994 and 2018. The registry collected important patient information such as demographic information (age, gender, and nationality), clinical details, and tumor classification. Results: The total number of cases with ocular cancer diagnosed was 1051 cases. The highest number was recorded in Riyadh (35.39%, n=372), followed by Makkah (16.93%, n=178). The incidence was higher in the 0-4 years' age group (55.21%), and it got down as people got older. The data also revealed differences in the number of reported cases over time, as well as in the representation of eye cancer cases by gender and nationality. While many ocular cancer pathologies were seen, with \"Retinoblastoma, not otherwise specified\" being the most common (53.32%), the incidence rates for males and females remained largely stable over time. Conclusion: The study emphasizes the need for continued monitoring, research, and analysis of potential of epidemiology of ocular cancer occurrence in Saudi Arabia. Identifying the geographical distribution and age pattern of Ocular malignancies have the potential to assist healthcare authorities and policymakers in developing precise strategies to reduce, recognize at an early stage, and successfully manage this condition. Keywords: ocular neoplasms, clinicopathologic characteristics, incidence rates, targeted strategies, retinoblastoma, Saudi Arabia

Introduction Social determinants of health (SDOH), including economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context, shape gaps in health outcomes across many conditions. Ocular neoplasms are no exception. Cancers such as uveal melanoma, conjunctival squamous cell carcinoma, ocular lymphoma, and ocular Kaposi sarcoma may be especially vulnerable to social and demographic influences. We systematically reviewed documented associations between SDOH and these ocular cancers in the United States. Methods Following a pre‐registered protocol, we searched MEDLINE, Embase, and Web of Science (from January 2000 to November 2023) for primary studies of any design that evaluated one or more relationships between SDOH and outcomes related to the ocular cancers listed above. Outcomes included cancer incidence, stage at diagnosis, treatment patterns, survival, and mortality. We extracted study design, population, exposure, and outcome characteristics, classified each exposure‐outcome association by its direction (e.g., favorable, unfavorable, or null), and assessed the risk of bias using a modified Newcastle‐Ottawa Scale. Due to heterogeneity in exposure and outcome definitions, we narratively synthesized findings by SDOH domain. Results We included 21 studies examining 167 unique associations. Social and community context, typically represented as race and ethnicity, was the most frequently studied domain, followed by economic stability (e.g., income) and healthcare access and quality (e.g., insurance type or travel distance). Across domains, lower socioeconomic status, public or no insurance, minority racial and ethnic identity, and care at academic centers generally are associated with later stage at diagnosis, higher odds of enucleation, or worse survival. Higher income, private insurance, and treatment at experienced facilities were often associated to earlier presentation and better outcomes. Conclusion SDOH have a measurable and often unfavorable relationship with the diagnosis, management, and prognosis of rare adult ocular cancers in the United States. Standardized SDOH exposures and measurements, prospective data collection, and adjustment for confounding are necessary to strengthen the evidence and guide multi‐domain interventions (e.g., expanded insurance, travel assistance to high‐volume centers, and community eye‐health initiatives) aimed at narrowing these gaps. Summary Not everyone with eye cancer in the United States receives the same quality of care. This review examined how social and economic factors affect survival and treatment outcomes for people with rare eye cancers (including uveal melanoma, ocular lymphoma, conjunctival squamous cell carcinoma, and ocular Kaposi sarcoma) by bringing together findings from 21 studies. We found that patients with lower incomes, less education, or public or no health insurance were more likely to be diagnosed at a later stage, more likely to have their eye surgically removed, and less likely to survive. People from racial or ethnic minority groups faced similar disadvantages. In contrast, patients with higher incomes and private insurance tended to be diagnosed earlier and have better chances of recovery. These findings make clear that where you start in life can shape where you end up in your cancer journey and that this is not inevitable. Improving access to health insurance, helping patients navigate their way to specialist care centers, and investing in community health education could all help close these gaps. People with eye cancer deserve the same chance of early diagnosis and effective treatment, regardless of their income, insurance status, or background.

Background Reports of neoplasms in Panthera species are increasing, but they are still an uncommon cause of disease and death in captive wild felids. The presence of two or more primary tumor in large felids is rarely reported, and there are no documented cases of ocular melanoma and mammary mucinous carcinoma in African lions. Case presentation An ocular melanoma and a mammary mucinous carcinoma are described in an African lion ( Panthera leo ). The first tumour was histologically characterized by the presence of epithelioid and fusiform melanocytes, while the latter was composed of mucus-producing cells with an epithelial phenotype that contained periodic acid-Schiff (PAS) and Alcian blue staining mucins. Metastases of both tumor were identified in various organs and indirect immunohistochemistry was used to characterize them. Peribiliary cysts were observed in the liver. Conclusions This is the first description of these tumor in African lions.

A 14-year-old female Dachshund was referred to a veterinary hospital with a history and signalment of head pressing, compulsive walking, and right circling. At ophthalmologic examination, a mature cataract and absence of photomotor reflex in the right eye were observed. The neurological exam revealed multifocal encephalic signs. At necropsy, a conical solid tan mass was observed involving the right optic nerve throughout its extension to the optic chiasm. Histopathological findings confirmed a retrobulbar papillary meningioma, considered rare and seldom included as differential diagnosis in patients with neurological signs. RESUMO: Uma fêmea Dachshund de 14 anos de idade foi encaminhada para um hospital veterinário universitário com histórico e manifestação de “head pressing”, andar compulsivo e em círculos para o lado direito. No exame oftalmológico foi diagnosticado catarata matura bilateral e ausência de reflexo fotomotor pupilar no olho direito. O exame neurológico revelou sinais encefálicos multifocais. Na necropsia, uma massa sólida cônica, branco-amarelada, foi observada envolvendo o nervo óptico em toda a sua extensão até o quiasma óptico. O exame histopatológico confirmou diagnóstico de meningioma papilar retrobulbar, considerado raro e pouco incluído no diagnóstico diferencial de pacientes com sinais neurológicos.

An Ocular Sebaceous Carcinoma (OSC) is a rare malignant tumor for which initial clinical and pathological diagnosis is often incorrect. OSCs can mimic Squamous Cell Carcinomas of the Conjunctiva (SCCC). The aim of this study was to find microRNA biomarkers to distinguish OSCs and SCCCs from normal tissue and from each other. Clinical OSC and SCCC case files and the corresponding histopathological slides were collected and reviewed. Micro dissected formalin-fixed paraffin-embedded tumor and control tissues were subjected to semi-high throughput microRNA profiling. MicroRNA expression distinguishes OSCs and SCCCs from corresponding control tissues. Selected differentially expressed miRNAs were validated using single RT-PCR assays. No prognostic miRNAs could be identified that reliably predict SCCC metastasis or OSC recurrence. A comparison between OSCs (n = 14) and SCCCs (n = 18) revealed 38 differentially expressed microRNAs (p < 0.05). Differentially expressed miRNAs were selected for validation in the discovery cohort and an independent validation cohort (OSCs, n = 11; SCCCs, n = 12). At least two miRNAs, miR-196b-5p (p ≤ 0.05) and miR-107 (p ≤ 0.001), displayed a statistically significant differential expression between OSCs and SCCCs with miR-196b-5p upregulated in SCCCs and miR-107 upregulated in OSCs. In the validation cohort, microRNA miR-493-3p also showed significant upregulation in SCCCs when compared to OSCs (p ≤ 0.05). ROC analyses indicated that the combined miR-196b-5p and miR-107 expression levels predicted OSCs with 90.0% sensitivity and 83.3% specificity. In conclusion, the combined testing of miR-196b-5p and miR-107, can be of additional use in routine diagnostics to discriminate OSCs from SCCCs.

Ocular surface squamous neoplasia (OSSN) is the most common nonpigmented ocular surface neoplasm. Interferon-alpha (IFNα)-2b has been proved to be an effective immunotherapeutic agent to treat OSSN. We have used intralesional and topical (36 μg/ml) pegylated (peg) IFNα-2a to treat a recurrent surgically failed case of OSSN instead of IFNα-2b. In this case report, we have shared our initial experience with the novel use of peg-IFNα-2a to treat OSSN. According to our brief clinical experience, peg-IFNα-2a is nontoxic to ocular surface and has a promising role to treat OSSN.

AIMS The results of 52 endoresections for choroidal melanoma are reported. METHODS The current technique involves vitrectomy, retinal incision over or peripheral to the tumour, haemostasis by raising intraocular pressure and by moderate hypotensive anaesthesia, choroidal incision around tumour, endoresection with vitrector, endodiathermy to bleeding points and residual tumour, fluid-air exchange to reattach retina, endolaser to achieve retinal adhesion around the coloboma and destroy residual tumour in the sclera, silicone oil injection with removal after 12 weeks, cryotherapy to the sclerotomies, and adjunctive ruthenium plaque radiotherapy in selected cases. RESULTS Patients receiving primary endoresection had a mean age of 53 years, a mean largest basal tumour diameter of 8.2 mm, and a mean tumour thickness of 3.9 mm. 40 tumours extended to within 2 disc diameters of the optic disc, with 17 involving disc. Follow up ranged from 40 days to 7 years (median 20 months). At the last visit, 90% of eyes were retained, with vision of 6/6–6/12 (two), 6/18–6/36 (three), 6/60 to counting fingers (18), hand movements (nine), and light perception (four). The main complications were retinal detachment in 16 and cataract in 25. Secondary endoresection (11) was performed after plaque radiotherapy (four), photocoagulation (four), trans-scleral local resection (two), and proton beam radiotherapy (one), with retention of the eye in nine cases. By the close of the study, no patients developed definite local tumour recurrence but one died of metastatic disease 41 months postoperatively. CONCLUSION Depending on tumour location, endoresection may conserve central vision or temporal field when radiotherapy would be expected to cause optic neuropathy. Longer follow up is necessary to establish the efficacy of tumour control.

A 56-year-old male patient presented with a slow-growing, elevated, smooth, white corneal mass. The mass was excised by performing an alcohol-assisted keratoepitheliectomy and sent for histopathological examination. Subepithelially, closely packed spindle cells in \"feather-stitched\" or storiform pattern were seen. Immunohistochemically, the cells stained negatively for CD-34 and S-100 and focal positivity was seen for vimentin. Based on the morphology and immunochemical staining, a diagnosis of corneal fibroma was made. No recurrence was seen. Corneal fibroma is an exceedingly rare, benign tumor and possibly lies on the same spectrum as corneal keloid and hypertrophic cicatrix. Surgical resection is usually curative.

Purpose To examine if the cells of human ocular surface neoplasms express sonic hedgehog (Shh) and the effects of topical mitomycin C on its expression. Methods Conjunctival tissues obtained from two normal subjects, two patients with squamous cell carcinoma of the ocular surface (conjunctiva), and one patient with ocular epithelial dysplasia were used in this study. Histological sections were processed for light microscopic immunohistochemical analysis for Shh. Results Faint immunoreactivity for Shh was detected in basal epithelial cells of limbus, bulbar, and palpebral conjunctival epithelial cells. On the other hand, squamous cell carcinoma cells markedly expressed Shh with positive staining for Patched 1(Ptc), the cell surface receptor of Shh. Similar marked expression of Shh was detected in the patient with ocular epithelial dysplasia, and this Shh expression was almost eliminated following topical mitomycin C treatment. A cell culture experiment was conducted to examine the effect of mitomycin C on Shh expression in a cultured squamous cell carcinoma cell line. Conclusions Conjunctival epithelium constitutively expresses a low level of Shh, and its expression increases during malignant conversion of epithelial cells. Reduction of Shh expression might be involved in the therapeutic efficacy of topical mitomycin C for ocular surface epithelial neoplasms.