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2013 ; 120
(12
): 2560-2564
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Diagnosis of occult melanoma using transient receptor potential melastatin 1
(TRPM1) autoantibody testing: a novel approach
#MMPMID24053997
Dalal MD
; Morgans CW
; Duvoisin RM
; Gamboa EA
; Jeffrey BG
; Garg SJ
; Chan CC
; Sen HN
Ophthalmology
2013[Dec]; 120
(12
): 2560-2564
PMID24053997
show ga
PURPOSE: To report the first case of melanoma-associated retinopathy (MAR) and
underlying occult melanoma diagnosed based on the presence of serum transient
receptor potential melastatin 1 (TRPM1) autoantibodies. DESIGN: Interventional
case report with basic science correlation. PARTICIPANTS: One patient with MAR.
INTERVENTION: Testing for the presence of serum TRPM1 autoantibodies. MAIN
OUTCOME MEASURES: Diagnosis of an occult melanoma involving the axillary lymph
nodes (unknown primary site) and MAR based on the presence of TRPM1
autoantibodies in the patient's serum. RESULTS: The patient's clinical exam was
remarkable for mild intraocular inflammation in both eyes and retinal hemorrhages
with an apparent choroidal neovascularization in the left eye, which was
confirmed by fluorescein angiography and indocyanine green angiography testing.
Humphrey visual field 30-2 SITA-fast (Humphrey Visual Field Analyzer, Carl Zeiss
Meditec, Inc, Dublin, CA) demonstrated diffuse depression in both eyes out of
proportion to the clinical exams, prompting electroretinography testing that
revealed an electronegative response. Dark-adapted thresholds were markedly
elevated and mediated by cones. Due to concern for MAR, a systemic work-up for
melanoma was performed by the primary care physician that was unrevealing. Given
our continued clinical suspicion for MAR, the patient's serum was sent for
evaluation for TRPM1 autoantibodies. The patient's serum applied to normal human
retina exhibited positivity in the inner nuclear layer. Application of the
patient's serum to wild-type and TRPM1 knockout mouse retina revealed strongly
labeled bipolar cells in the wild-type retina, but not in the TRPM1 knockout
retina, indicating TRPM1-dependent immunoreactivity. The antigen was confirmed as
TRPM1 by labeling of TRPM1-transfected human embryonic kidney 293 cells.
Additional systemic work-up prompted by this finding resulted in identification
of an occult metastatic melanoma involving the axillary lymph nodes with an
unknown primary site. The patient underwent surgical excision of the occult
melanoma without evidence of other sites of metastases. He also received
intravenous immunoglobulin therapy and his vision has stabilized. CONCLUSIONS:
This is the first reported case of a melanoma-associated retinopathy diagnosed
utilizing the innovative approach of testing for serum TRPM1 autoantibodies.