2023-06-28 12:09:04
An uveal melanoma is rare: it occurs about 250 times a year. A significant number of patients die from this form of eye cancer. The LUMC treats about 95 percent of all cases in the Netherlands. Most eye melanomas occur in people between the ages of 50 and 70. Because the survival rate of patients is partly related to the size of the tumour, it is important that the melanoma is detected as soon as possible.
For his PhD at the LUMC, Niels Brouwer conducted research into two types of eye melanoma: uveal melanoma and conjunctival melanoma. His research focused on new imaging techniques and the genetics and immunology of uveal melanoma. His findings provided starting points for new treatments. On 23 June, he received the Donders-Binkhorst Prize from the Nederlands Oogheelkundig Gezelschap (NOG) for his dissertation.
Meeting of expertise in ophthalmology and oncology
As new imaging techniques, Brouwer used photo and scanning equipment in the LUMC, some of which were already used for retinal disorders (retinal oximetry and OCT angiography). For example, he brought together the expertise that the LUMC has in the field of ophthalmology and oncology in a beautiful way. Brouwer: “We were the first to be able to image certain tumors on the conjunctiva (the mucous membrane of the eye). We were also able to characterize tumors in detail in the laboratory.”
When it comes to making a diagnosis, a doctor needs to know whether a spot on or in the eye is benign or malignant. You have to treat a melanoma, but not a birthmark. At the moment, this usually requires an invasive (surgical) technique or procedure. For example, by injecting a dye into the arm that enters the eye via the blood (fluorescence angiography) or by removing eye tissue.
More patient-friendly
The new imaging techniques are much more patient-friendly and the examinations also take less time. A patient only has to keep his or her eye in front of a device. Using a special type of photography, the structure of the blood vessels and the oxygen contained in those blood vessels are examined. “Vascular growth is a distinction between a melanoma and a birthmark. A melanoma grows faster than a mole and therefore needs more blood vessels to supply itself with blood and oxygen. A melanoma will therefore form different blood vessels than a quiet birthmark, which has been there for a long time,” explains Brouwer.
The imaging techniques are also promising for seeing radiation damage, which can occur after treatment of an eye tumor. Furthermore, there is additional evidence for the already prevailing view that there is a lot of overlap in the genetic background of conjunctival melanoma and cutaneous melanoma. “That means that you can use the same types of immunotherapy for conjunctival melanoma as for cutaneous melanoma,” says Brouwer.
LUMC is leading the way
The LUMC is the first hospital that can map blood vessels in tumors using these techniques. However, it is not yet part of the standard procedure for detecting melanoma. More patients are needed to demonstrate what the technique adds to current studies, which is difficult given the rarity of the disease. International cooperation in this area is therefore crucial, according to Brouwer.
For uveal melanoma, the most common type of eye melanoma, the aforementioned comparison with cutaneous melanoma does not apply and treatments – especially for metastases – are less close. That is why it remains crucial that patients end up at the center of expertise in the LUMC as quickly as possible.
One problem is that uveal melanoma on the outside of the eye is usually not visible. According to Brouwer, this is an important task for ophthalmologists, who can refer patients. “Some of the patients are found by chance. During a driver’s license test or diabetes check, for example. That is why you want them to be referred quickly,” he says. According to Brouwer, the same applies to suspicious spots on the outside of the eye, which can be seen, but which the ophthalmologist may not realize are malignant. The LUMC therefore informs ophthalmologists about this during meetings and conferences.
The LUMC has years of experience with uveal melanoma and treats most cases in the Netherlands. The ophthalmology laboratory is part of the ophthalmology department. Tumors are also examined there. There is also extensive collaboration with the radiotherapy department and the HPTC proton center in Delft, where proton irradiation has provided a new treatment option for eye melanoma for several years now.
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