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• W2969242571 abstract "I read with interest the report by Ip et al1Ip M.H. Tat L. Coroneo M.T. Primary acquired melanosis treated with combination interferon and retinoic acid.Ophthalmology. 2018; 125: 1994-1996Scopus (2) Google Scholar on the chemotherapeutic treatment of primary acquired melanosis (PAM). The authors hypothesized that use of a combination of topical interferon (IFN)-alpha 2b (1 000 000 UI/ml) 4 times daily plus retinoic acid (0.01%) once daily may explain the longer tumor-free duration compared with that afforded by IFN alone. Any improvements in the management of this oncological, ocular surface disease (a melanoma) that may develop in 50% of cases of ocular atypia are of great interest to specialists. Usually, topical chemotherapy is not the initial treatment for PAM or melanoma.2Wong J.R. Nanji A.A. Galor A. Karp C.L. Management of conjunctival malignant melanoma: a review and update.Expert Rev Ophthalmol. 2014; 9: 185-204Crossref PubMed Scopus (66) Google Scholar However, in patients with recurrent or very extensive disease, this may be the best option.2Wong J.R. Nanji A.A. Galor A. Karp C.L. Management of conjunctival malignant melanoma: a review and update.Expert Rev Ophthalmol. 2014; 9: 185-204Crossref PubMed Scopus (66) Google Scholar Mitomycin C is the chemotherapeutic agent most commonly used.3Fernandes B.F. Nikolitch K. Coates J. et al.Local chemotherapeutic agents for the treatment of ocular malignancies.Surv Ophthalmol. 2014; 59: 97-114Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar However, given the potentially severe side effects, other agents including INF-alpha 2b have been prescribed for isolated cases or in short case series.3Fernandes B.F. Nikolitch K. Coates J. et al.Local chemotherapeutic agents for the treatment of ocular malignancies.Surv Ophthalmol. 2014; 59: 97-114Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar The authors compare their results with those of 3 previous reports that employed only topical IFN to treat PAM (Table S1, in the original article). However, the authors do not cite some reports indicating that topical IFN was a satisfactory initial treatment, successfully eradicating PAM.4Huerva V. Traveset A.E. Vilardell F. Topical interferon alpha-2b for diffuse conjunctival primary acquired melanosis with atypia.Ocul Immunol Inflamm. 2017; 25: 284-286Google Scholar The duration of treatment in reference 1 of Table S1 was 6 to 24 months; that of reference 3 was a mean of 14.4 weeks; and, in a report not included in Table S1,4Huerva V. Traveset A.E. Vilardell F. Topical interferon alpha-2b for diffuse conjunctival primary acquired melanosis with atypia.Ocul Immunol Inflamm. 2017; 25: 284-286Google Scholar the duration was 12 weeks according to reference 2 of Table S1. It is surprising that Ip et al1Ip M.H. Tat L. Coroneo M.T. Primary acquired melanosis treated with combination interferon and retinoic acid.Ophthalmology. 2018; 125: 1994-1996Scopus (2) Google Scholar continued combination treatment for 52 weeks, much longer than other studies. This factor may compromise patient compliance. If the agents indeed act synergistically, the required treatment duration should be much shorter. However, we have observed that residual pigmentation may continue to disappear after cessation of IFN treatment before total PAM eradication.4Huerva V. Traveset A.E. Vilardell F. Topical interferon alpha-2b for diffuse conjunctival primary acquired melanosis with atypia.Ocul Immunol Inflamm. 2017; 25: 284-286Google Scholar Thus, the duration of IFN required for complete PAM resolution remains unclear. How quickly can we conclude that IFN treatment has been effective so that we may stop treatment? If combining IFN with retinoic acid does not reduce treatment duration, the principal advantage of combination treatment (as suggested by Ip et al) would be a longer tumor-free duration than afforded by IFN alone. Ip et al reported a mean of 96.3 months of PAM-free follow-up, longer than most tumor-free periods listed in Table S1. However, we earlier reported (case 1)5Matas-Nadal C. Sòria X. García-de-la-Fuente M.R. et al.Immunocryosurgery as monotherapy for lentigo maligna or combined with surgical excision for lentigo maligna melanoma.J Dermatol. 2018; 45: 564-570Google Scholar a case of PAM associated with eyelid lentigo maligna treated with IFN alone; no recurrence was noted over 72 months of follow-up. More case series featuring longer follow-up after only IFN treatment are required to explore whether IFN combined with retinoic acid is more effective than IFN alone in terms of preventing PAM recurrence. Primary Acquired Melanosis Treated with Combination Interferon and Retinoic AcidOphthalmologyVol. 125Issue 12PreviewPrimary acquired melanosis (PAM) represents one form of conjunctival melanocytic tumor. Primary acquired melanosis is an acquired conjunctival lesion classified into 2 forms: with and without atypia.1 Primary acquired melanosis with atypia may evolve into conjunctival malignant melanoma.2 Complete excision is recommended for PAM; however, excision may not be feasible with diffuse or larger lesions. With larger diffuse lesions, a map biopsy may be used instead.1 Full-Text PDF ReplyOphthalmologyVol. 126Issue 9PreviewWe would like to thank Dr Huerva for his comments regarding our report on 5 cases of biopsy-proven primary acquired melanosis (PAM) with atypia treated with topical combination interferon (IFN) and retinoic acid (I/RA). Full-Text PDF" @default.
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• W2969242571 title "Re: Ip et al.: Primary acquired melanosis treated with combination interferon and retinoic acid (Ophthalmology. 2018;125:1994-1996)" @default.
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