Clinical and Histologic Findings in Patients With Uveal Melanomas After Taking Tumor Necrosis Factor-α Inhibitors

Objective: To describe the progression of uveal melanocytic lesions to melanomas after initiation of tumor necrosis factor-alpha (TNF-alpha) inhibitors. Patients and Methods: We report 3 cases of uveal melanoma occurring after treatment with TNF-alpha inhibitors, 2 from Mayo Clinic and 1 from Yale University. The study took place from February 27, 2009, through July 15, 2013. Results: Two women and one man with inflammatory disease who received TNF-alpha inhibitors had subsequent development of uveal melanomas. The 2 women had inflammatory bowel disease and had been followed up for melanocytic tumors that grew markedly within 1 year after beginning treatment with TNF-alpha inhibitors to the point of requiring treatment. One had histologic confirmation of the melanoma. The male patient had rheumatoid arthritis that was being treated with TNF-alpha inhibitors. Serial ultrasonography was performed to monitor bilateral diffuse scleritis, and within 16 months of initiation of TNF-alpha inhibitor therapy, a choroidal mass was detected that continued to grow over the next 3 months. The patient elected to have enucleation, which revealed uveal melanoma and thinning of the sclera from the previous scleritis. Conclusion: Our 3 cases of uveal melanocytic tumors occurring after the use of TNF-alpha inhibitors add to the growing literature suggesting a correlation between TNF-alpha inhibitors and the development of malignant neoplasms. Considering the association between cutaneous melanoma and TNF-alpha inhibitors, we recommend that patients have an eye examination before initiation of TNF-alpha inhibitors, and those with preexisting nevi should be followed up at regular intervals. (C) 2014 Mayo Foundation for Medical Education and Research