Uveal melanoma following Bruton's tyrosine inhibitor use for the treatment of hematologic malignancies

Abstract

Purpose: To report two new cases and summarize one case of uveal melanoma following treatment of hematologic malignancies with Bruton's tyrosine kinase inhibitors.

Observations: A 71-year-old male, with a history of Waldenstrom macroglobulinemia treated with an anti-CD20 antibody and BTKi, was diagnosed with a choroidal melanoma with intraocular metastasis. A 73-year-old female, with a history of Mantle Cell Lymphoma treated with an alkylating chemotherapy and an anti-CD20 antibody, relapse, and subsequent treatment with BTKi, was diagnosed with a uveal melanoma.

Conclusions and importance: Patients being treated with BTK inhibitors may be at higher risk for the development of uveal melanoma. Based on our findings, we recommend increased surveillance of this patient population for secondary primary or metastatic uveal melanoma. Continued documentation of occurrence in conjunction with research at a molecular and cellular level are warranted to better understand the impact of systemic cancer therapies on secondary malignancies.

Keywords: Bruton's tyrosine kinase inhibitor; Hematologic malignancy; Uveal melanoma.

Fig. 1

Imaging of a 71-year-old patient with a uveal melanoma of the left eye: (A) Slit lamp examination shows 3+ nuclear sclerotic cataract and a pigmented anterior iris lesion emanating from the iris root (black arrow). (B) 20 MHz B scan ultrasonography demonstrates a large anterior uveal melanoma apical thickness of 9.9 mm. (C) Ultrasound biomicroscopy demonstrates the anterior location of the tumor with ciliary body focus and iris root breakthrough.

Fig. 2

Imaging of a 73-year-old patient with a uveal melanoma of the right eye: (A) Slit lamp examination shows dilated, tortuous sentinel scleral vessels inferotemporally (black arrow). (B) Ultrawidefield fundus photography demonstrates the large anteriorly placed choroidal mass (white arrow). (C) 20 MHz B scan ultrasonography demonstrates a large anterior uveal melanoma with apical thickness of 13.61 mm.