A clinical case of the development of choroidal neovascularization in a patient with skin melanoma on the background of therapy with MEK and BRAF inhibitors

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Abstract

The emergence of targeted therapy has become a significant breakthrough in the management of cancer patients, but even it is not without drawbacks. The article describes a clinical case of the development choroidal neovascularization in a 42-year-old patient with stage IV skin melanoma during 15 months of therapy with MEK and BRAF inhibitors. Clinicians need to remember that such patients may have not only MEK-associated retinopathy, but also other pathological changes in the retina, in particular choroidal neovascularization, which may be associated with both the chemotherapy they receive and the paraneoplastic syndrome itself against the background of the course of the underlying disease. Timely diagnosis and adequate management tactics allow such patients to preserve visual functions.

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About the authors

Natalia V. Tkachenko

Pavlov First St. Petersburg State Medical University

Email: natalyatkachenko@yandex.ru
SPIN-code: 5187-3670

Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Svetlana G. Belekhova

Pavlov First St. Petersburg State Medical University

Author for correspondence.
Email: beleksv@yandex.ru
ORCID iD: 0000-0003-0293-4811
SPIN-code: 3637-7441

Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Natalia V. Zhukova

Saint Petersburg State University; City Clinical Oncological Dispensary

Email: drnvz@yandex.ru
ORCID iD: 0000-0002-0619-2205
SPIN-code: 3480-2098

Cand. Sci. (Med.), Assistant professor, Head of the Chemotherapeutic Department

Russian Federation, Saint Petersburg; Saint Petersburg

Vera S. Prokopchuk

Pavlov First St. Petersburg State Medical University

Email: prokopchuk.vera98@gmail.com
ORCID iD: 0000-0003-3310-6234

Student

Russian Federation, Saint Petersburg

Natalya S. Chernova

Almazov National Medical Research Centre

Email: demod@list.ru

Ophthalmologist

Russian Federation, Saint Petersburg

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Supplementary files

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2. Fig. 1. Funduscopy. There is a subretinal hemorrhage in the foveal zone, a yellow-grey rounded focus with a diameter of about 1/3 of the optic disc above the foveola

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3. Fig. 2. Optical coherence tomography of the right eye: neuroepithelial detachment, hyperreflective subretinal focus under the neuroepithelium (CNV type 2)

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4. Fig. 3. Fluorescein angiography of the central part of the retina of the right eye. Аrterio-venous phase of the study, hyperfluorescence and accumulation of dye in the zone of choroidal neovascularization

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5. Fig. 4. Optical coherence tomography 4 months before the appearance of choroidal neovascularization. On the slice in the parafoveal zone, a slit-like detachment of the pigment epithelium is determined, which was not present at patient previous visit

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6. Fig. 5. Development of choroidal neovascularization: horizontal linear OCT-scan on one of the first visits after the start of treatment with a MEK-inhibitors (a): after 15 months of treatment, the appearance of neuroepithelial detachment, hyperreflective subretinal focus — CNV (b); there is an increase in the size of the hyperreflective subretinal focus (c); the same OCT-scan on subsequent visits against the background of renewed anti-VEGF therapy, a noticeable decrease in the size of the subretinal membrane, an increase in the reflexivity and density of the focus (d, e)

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Copyright (c) 2022 Tkachenko N.V., Belekhova S.G., Zhukova N.V., Prokopchuk V.S., Chernova N.S.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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