Clinical aspects of conjunctival melanoma

Unilateral amelanotic conjunctival malignant melanoma: a case report

INTRODUCTION

Cutaneous malignant melanomas rarely occur in the eye, usually in the eyelids or the conjunctiva. Conjunctival malignant melanomas are even rarer. Most melanomas are dark in color as they are pigmented. However, amelanotic conjunctival malignant melanomas, a scarce variant of the cancer, can be challenging to diagnose accurately.

CASE PRESENTATION

We present two cases of white Caucasian Swedish-born women who were diagnosed with unilateral amelanotic malignant melanoma in the conjunctiva of the eye. In the first case, the patient was an 81-year-old woman who was suffering from redness and foreign body sensation in the left eye. The initial diagnosis was blepharitis. Three biopsies were taken, which showed malignant melanoma in the eyelid and the conjunctiva. Unfortunately, the eye and the rest of the orbit could not be saved, and the patient had to undergo an orbital exenteration. In the second case, the patient was a 50-year-old woman, and the tumor was localized in the temporal conjunctiva of the left eye. The initial diagnosis was pinguecula, but at the time of surgery, the physician suspected conjunctival intraepithelial neoplasia. The tumor was not completely removed, so adjuvant brachytherapy and local chemotherapy were used. The eye was preserved. No neck and/or lung metastasis was detected in either case at the time of diagnosis.

CONCLUSIONS

Conjunctival amelanotic malignant melanomas should be suspected when tumors are present in the eye and/or the eyelids. By suspecting amelanotic malignant melanoma, the delay in treatment can be shortened. Treating them as soon as possible is essential to minimize the risk of metastasis.

Advances in the management of conjunctival melanoma

Malignant melanoma of the conjunctiva is a rare but serious condition. Over the last several years, there have been important advances in the classification, diagnosis, and treatment of this condition. Recent cytogenetic and immunohistochemical studies are increasing understanding of its tumorigenesis. Diagnosis, although still made via histopathology, has been aided with imaging techniques such as ultrasound biomicroscopy and anterior segment optical coherence tomography. Primary treatment consists of surgical excision. But adjuvant treatments with cryotherapy, topical chemotherapy, and radiation therapy have shown increased success. Sentinel lymph node biopsy has shown early promise of detecting micro-metastasis. Long term follow-up of patients with conjunctival melanoma with systemic surveillance is necessary to detect recurrences and metastases.

Excision with corneoscleral lamellar keratoplasty and amniotic membrane transplantation of a corneal displaced recurrent conjunctival melanoma

An 81-year-old woman with a raised pigmented nodule over her left cornea for 7 months duration was examined. Dark conjunctival pigmentation was observed in the upper bulbar fornix conjunctiva. She had previously undergone primary surgical excision of a malignant conjunctival melanoma four years earlier. The tumor separated easily from the corneal surface, but remained slightly attached to the corneoscleral surface. A corneoscleral lamellar dissection of 3 mm in width and 2 mm in depth as well as a corneoscleral lamellar keratoplasty for the reconstruction of the corneoscleral defect were performed. The wide upper bulbar and fornix conjunctiva were excised, and an amniotic membrane transplantation was performed. Biopsy revealed an invasive melanoma with a depth of 1 mm. Left, right, and inferior tumor margins of the corneoscleral lesion and the pigmentary lesion in the conjunctiva were free of the tumor. After surgery, 0.04% mitomycin was administered topically 4 times daily for 4 weeks. There was no recurrence 2 years after surgery, and systemic evaluation revealed no metastasis.

Conjunctival melanoma in a six-year-old female

Conjunctival melanoma (CM) is a highly malignant tumor that derives from melanocytes and is rarely seen in children. This report describes a 6-year-old female diagnosed with CM.

Role of topical chemotherapy for primary acquired melanosis and malignant melanoma of the conjunctiva and cornea: review of the evidence and recommendations for treatment

Surgical excision with cryotherapy is a well-established treatment option for malignant melanoma or primary acquired melanosis (PAM) with atypia of the conjunctiva and cornea. Topical chemotherapeutic agents such as mitomycin C (MMC) however, are increasingly finding use in clinical practice. A search was performed of Medline and Pubmed databases for English language articles from 1980 to the present in this field. Relevant studies were reviewed with regards to treatment regimen, rates of recurrence and metastasis, side effect profile and length of follow up. A total of 22 and 16 unique cases of biopsy proven PAM with atypia and malignant melanoma, respectively, treated with topical MMC were identified. Topical MMC was well tolerated and shows considerable promise, particularly in the treatment of diffuse PAM with atypia. However, long-term data are lacking and further studies are required.

Digital surface microscopy analysis of conjunctival pigmented lesions: a preliminary study

The objective of this study was to investigate whether digital surface microscopy (DSM) could be used for the follow-up and comparison of malignant and benign conjunctival pigmented lesions (CPLs). Thirty-nine CPLs [16 de novo malignant melanomas (MMs), one MM arising from primary acquired melanosis (PAM), six PAMs and 16 naevi] were digitally analysed and biopsied. All of the PAMs and 10 naevi, which had not been surgically excised, were followed up using DSM. Thirty parameters were evaluated grouped into four categories: geometry, colour, texture and islands of colour. None of the CPLs that were followed up, which comprised 10 naevocytic naevi and seven PAMs, showed any morphological change at DSM analysis, except for one PAM which developed an MM 1 year later. Of the geometric variables examined, the area, maximum diameter and minimum diameter showed significantly higher values in MMs compared with benign CPLs. With regard to the colour of CPLs, MMs were significantly darker and bluer than naevi. In the texture group, contrast was significantly higher in MMs. In the islands-of-colour group, the imbalance of blue-grey regions and the presence of dark areas were significantly higher in MMs. DSM greatly simplified the follow-up of CPLs, such as PAMs with atypia, by providing satisfactory quality images with high reproducibility; this technique is also easy to use and well accepted by patients. Moreover, this preliminary study allowed us to determine which objective variables could be important for distinguishing between benign CPLs and conjunctival MMs.