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Çalış Karanfil F, Gündüz AK, Gündüz ÖÖ, Özalp Ateş FS. Factors affecting recurrence and metastasis in conjunctival melanoma. Int Ophthalmol 2023; 43:4203-4215. [PMID: 37639080 DOI: 10.1007/s10792-023-02830-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/27/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE To evaluate clinical and demographic characteristics and factors affecting recurrence, metastasis, and survival in conjunctival melanoma (CM). METHODS The clinical records of 45 patients who were treated for CM between October 1998 and June 2022 were retrospectively evaluated. Age, gender, presence of underlying conjunctival nevus-primary acquired melanosis (PAM), tumor stage according to the 8th edition of the American Joint Committee on Cancer (AJCC) staging system, tumor basal diameter, tumor thickness, lymph node (LN) involvement, metastasis, presence of tumor at the surgical margin, treatment method, need for adjuvant therapy, local tumor control, recurrence, and survival were recorded. RESULTS Twenty-one (46.7%) patients were female and 24 (53.3%) patients were male. The mean age at diagnosis was 53.2 ± 16.1 years. Median follow up time was 12 (1-300) months. Fifteen (33.3%) patients had conjunctival PAM; 2 (4.4%) patients had conjunctival nevus. The tumor stage was T1 in 24 (55.8%), T2 in 13 (30.2%), and T3 in 6 (14.0%) of the cases. The T stage in 2 cases could not be determined. For stage T1 and T2 CM, in addition to excisional biopsy (EB) and cryotherapy, alcohol epitheliectomy (AE) was performed in 17 cases (37.8%), superficial sclerectomy (SS) was performed in 7 (15.6%), and amnion membrane transplantation (AMT) due to a large conjunctival defect in 9 (20.0%). Six (14.0%) T3 cases underwent primary exenteration. Positive surgical margins were observed in 23 (51.1%) of the excised tumors at histopathologic examination. Adjuvant topical mitomycin-C (MMC) was used in 7 (30.4%) and strontium-90 episcleral brachytherapy in 4 (17.4%) of the 23 cases with tumor-positive borders. During the follow-up, recurrence was seen in 14 (31.1%) cases. According to Kaplan Meier analysis, the mean time to recurrence development was 90.5 ± 16.1 months and the 5-year recurrence free rate was 52.0%. Fourteen of the recurrent cases underwent EB + cryotherapy, 3 underwent AE + SS, and 3 underwent secondary exenteration. Metastasis and LN involvement occurred in 11 (24.4%) and 8 (17.8%) of the cases, respectively. Four (8.9%) cases expired during follow-up. According to Kaplan-Meier analysis, the mean time to metastasis was 106.2 ± 17.3 months and the 5-year metastasis free rate was 52.0%. While recurrence was more frequent in CM developing from PAM/nevus, metastasis was more frequent in men and those with LN involvement. CONCLUSION Conjunctival melanoma was a malignant tumor with high recurrence and metastasis rates. Precursor nevus/PAM is a risk factor for recurrence, while male gender and regional LN involvement were risk factors for metastasis in this study.
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Affiliation(s)
- Feyza Çalış Karanfil
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey.
| | - Ahmet Kaan Gündüz
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ömür Özlenen Gündüz
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Funda Seher Özalp Ateş
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
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Oh AJ, Glasgow BJ. Dendritic Melanocytic Hyperplasia in Pterygia: A Potential Source of Diagnostic Confusion with Primary Acquired Melanosis. Ocul Oncol Pathol 2023; 9:48-55. [PMID: 38376097 PMCID: PMC10821784 DOI: 10.1159/000530514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/27/2023] [Indexed: 02/21/2024] Open
Abstract
Introduction The aim of this study was to report the nearly ubiquitous prevalence of melanocytic hyperplasia in benign pterygia/pingueculae and establish that the entity is insufficiently recognized. Methods This is a retrospective immunohistochemical pathology case series of 30 consecutive pterygia/pingueculae samples selected from an ophthalmic pathology database at a single institution. Histopathologic and immunohistochemistry analyses with anti-SOX-10 and anti-MART-1 antibodies were used for identifying melanocytes. The number of squamous cells intervening between melanocytes was determined. Results The frequency of dendritic melanocytes was found to meet the criteria for dendritic melanocytic hyperplasia in 29 of 30 pterygia/pingueculae samples using specific antibodies. Melanocytes were found in several patterns: diffuse (28%), multifocal (28%), and focal (44%). In each case, the melanocytes were distributed as single melanocytes at the base; clusters of melanocytes were seen in 17% of samples. There were an average of about two intervening epithelial cells between melanocytes at the base. Conclusion When diagnosed with immunohistochemistry, dendritic melanocytic hyperplasia is nearly ubiquitous in pterygia and pingueculae. Melanocytic hyperplasia may have a distribution that includes nests and single melanocytes above the basal layer, which can be confused with forms of primary acquired melanosis. It is important for pathologists to recognize these lesions as a distinct benign clinicopathologic entity.
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Affiliation(s)
- Angela J. Oh
- Departments of Ophthalmology, Los Angeles, CA, USA
| | - Ben J. Glasgow
- Departments of Ophthalmology, Los Angeles, CA, USA
- Pathology and Laboratory Medicine, Jules Stein Eye Institute, University of California, Los Angeles, CA, USA
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Shree N, Gandhi A, Das S. Giant facial congenital melanocytic nevus associated with conjunctival melanoma. Orbit 2023:1-4. [PMID: 37058098 DOI: 10.1080/01676830.2023.2198002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Giant congenital melanocytic nevi involving the face are benign lesions and malignant transformation to cutaneous melanoma involving the eyelid has been rarely reported. This report highlights the rare association of a giant facial melanocytic nevus and conjunctival primary acquired melanoses and melanoma.
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Affiliation(s)
- Neha Shree
- Oculoplasty and Ocular Oncology Services, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Arpan Gandhi
- Laboratory Services, Dr Shroff's Charity Eye Hospital, New Delhi, India
| | - Sima Das
- Oculoplasty and Ocular Oncology Services, Dr Shroff's Charity Eye Hospital, New Delhi, India
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Svedberg K. Recurrence of Primary Acquired Melanosis and Conjunctival Intraepithelial Neoplasia. Ocul Oncol Pathol 2023; 8:236-241. [PMID: 36925733 PMCID: PMC10013497 DOI: 10.1159/000526985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/02/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction The aim of this study was to investigate the frequency of recurrences, time to recurrence, and which patients had a recurrence after treatment of conjunctival intraepithelial neoplasia (CIN), carcinoma in situ, and primary acquired melanosis (PAM) with atypia. Methods A retrospective chart review of all patients included in the follow-up program after completion of treatment for CIN or PAM with atypia on October 18, 2021, at the Department of Ophthalmology, Sahlgrenska University Hospital, was conducted. Results There were five recurrences (5/31, 17%) in the group with CIN or carcinoma in situ: two for patients with CIN grade II and three for individuals with carcinoma in situ. Time to diagnosis of recurrence ranged from 6 to 288 months. No recurrence was diagnosed for the 26 patients followed after treatment for PAM with atypia. Conclusion With the strategy of radical treatment for CIN and PAM with atypia, whenever possible, subsequent follow-up can probably be ceased after 10 years if the patient is not immunocompromised. For completely excised PAM with atypia grade I, there is most likely no need for further clinical controls.
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Affiliation(s)
- Karin Svedberg
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Ophthalmology, Sahlgrenska University Hospital, Region Västra Götaland, Mölndal, Sweden
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5
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Huerva V, Vilardell F, Cid-Bertomeu P. Cryotherapy after Topical Interferon Alpha 2b to Treat Conjunctival Primary Acquired Melanosis. Case Rep Ophthalmol 2023; 14:111-114. [PMID: 36968810 PMCID: PMC10035544 DOI: 10.1159/000529667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/07/2023] [Indexed: 03/29/2023] Open
Abstract
When primary acquired melanosis (PAM) with atypia affects the tarsal conjunctiva, a radical surgery can be mutilating, requiring reconstructive surgery of the eyelid. Topical chemotherapy associated to local cryotherapy may be an alternative. A 64-year-old Caucasian female presented with diffuse PAM of the right eye involving the inferior tarsal conjunctiva, fornix, and inferotemporal bulbar conjunctiva. Histological study showed a PAM with atypia (C-MIN 5). Given the extent of the lesion and its location, a wide mutilating excision was ruled out. Topical interferon alpha 2b (IFN-α2b) treatment (1,000,000 IU/mL, 4 times a day) was administered during 10 weeks. However, the regression was very slow. Then local cryotherapy was proposed (8 s at -80°C per application) to the entire pigmented lesion. This afforded progressive depigmentation, which was completed 2 months later. No recurrence of the lesion has been noted during 3 years of follow-up. The combination of the two procedures reduces IFN-α2b eyedrop administration time, enhancing patient compliance. The combination may eradicate the tumor without compromising ocular cosmesis.
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Affiliation(s)
- Valentín Huerva
- Department of Ophthalmology, University Hospital Arnau de Vilanova, Lleida, Spain
- School of Medicine, University of Lleida, Lleida, Spain
| | - Felip Vilardell
- Department of Pathology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Pau Cid-Bertomeu
- Department of Ophthalmology, University Hospital Arnau de Vilanova, Lleida, Spain
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Garza-Garza LA, Ramos-Davila EM, Ruiz-Lozano RE, Gutierrez-Juarez K, Hernandez-Camarena JC. Clinical profile of melanocytic lesions of the ocular surface in a Hispanic population. Int Ophthalmol 2022; 42:2765-2772. [PMID: 35438422 DOI: 10.1007/s10792-022-02266-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 03/12/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the prevalence, clinical characteristics, and demographic factors of melanocytic lesions of the ocular surface, such as racial melanosis, primarily acquired melanosis, conjunctival nevus, and conjunctival melanoma in a Hispanic population. MATERIALS AND METHODS A cross-sectional and observational study was undertaken in a tertiary referral ophthalmological center in northern Mexico from December 2020 to April 2021. All patients attending an ophthalmology specialty clinic were screened during their first visit in order to detect melanocytic lesions of the ocular surface. Demographic factors, clinical characteristics, and diagnosis and treatment were recorded. RESULTS 227 patients were screened for melanocytic lesions. Melanocytic lesions were identified in 114 patients (50.2%). The prevalence of the different melanocytic lesions in the screened population was racial melanosis, 45.3%; primary acquired melanosis, 3.5%, and conjunctival nevus 1.3%. No conjunctival melanoma was identified in the screened population. Primary acquired melanosis was more common in the fifth to sixth decade of life and in females. Racial melanosis showed no gender predilection and was also more common in the fifth to sixth decade of life. Only 1 melanocytic lesion (a primary acquired melanosis) required medical treatment with excisional biopsy and cryotherapy. CONCLUSION The prevalence of racial melanosis is remarkably high in the Hispanic population. While less prevalent, primary acquired melanosis is also present in a considerable percentage of Hispanic patients. Both melanocytic lesions exhibit demographic characteristics that match those previously reported in the medical literature.
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Affiliation(s)
- Lucas A Garza-Garza
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Batallon de San Patricio 112, 1st Floor. Real de San Agustin, 66278, Monterrey, NL, Mexico
| | - Eugenia M Ramos-Davila
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Batallon de San Patricio 112, 1st Floor. Real de San Agustin, 66278, Monterrey, NL, Mexico
| | - Raul E Ruiz-Lozano
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Batallon de San Patricio 112, 1st Floor. Real de San Agustin, 66278, Monterrey, NL, Mexico
| | - Kathia Gutierrez-Juarez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Batallon de San Patricio 112, 1st Floor. Real de San Agustin, 66278, Monterrey, NL, Mexico
| | - Julio C Hernandez-Camarena
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Batallon de San Patricio 112, 1st Floor. Real de San Agustin, 66278, Monterrey, NL, Mexico.
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Yeung A, Uner OE, Wells JR, Grossniklaus HE. Clinical and Histopathological Features of Corneal Primary Acquired Melanosis and Melanoma. Ocul Oncol Pathol 2021; 7:103-107. [PMID: 33981694 DOI: 10.1159/000511596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/14/2020] [Indexed: 11/19/2022] Open
Abstract
Aim The aim of this study is to describe the clinical and pathologic features of corneal primary acquired melanosis (PAM) and melanoma. Methods We describe 3 cases in total: two cases of corneal melanomas and 1 case of corneal PAM. The eyes were processed routinely for histopathological examination. Clinical histories, treatments, and outcomes were reviewed. Results Corneal melanomas arose from recurrence of conjunctival melanoma or conjunctival PAM at the limbus. One patient had a recurrence after excision of a limbal melanoma, another had a de novo corneal melanoma, and the last patient had corneal PAM in the setting of conjunctival PAM with atypia. All lesions were excised with adjuvant alcohol debridement and cryotherapy with no recurrence ranging from 1 week to 8 years. Conclusions Corneal melanomas arise at the limbus from corneal PAM or conjunctival atypia. They can appear after excisional removal of a conjunctival melanoma. Surgical excision with alcohol debridement and adjuvant cryotherapy is successful.
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Affiliation(s)
- Aaron Yeung
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ogul E Uner
- School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Jill R Wells
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hans E Grossniklaus
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA
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Roelofs KA, Mitsopoulos G, Cohen VML. Conjunctival Melanoma with Ipsilateral, Non-Contiguous Eyelid Involvement: A Case Report and Comprehensive Review of the Literature. Ocul Oncol Pathol 2020; 6:333-338. [PMID: 33123526 DOI: 10.1159/000506950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/01/2020] [Indexed: 11/19/2022] Open
Abstract
While the majority of cases of conjunctival melanoma (CM) involve the bulbar conjunctiva, concurrent pigmentation of the ipsilateral eyelid can be seen in up to 15% of cases. Although extension of conjunctival melanoma into the eyelid (AJCC cT3b) occurs in 1% of cases, non-contiguous lesions are very rare with only 5 clearly documented reports in the English literature. Several pathophysiological mechanisms have been proposed, including separate primary melanomas, patchy involvement from primary acquired melanosis (which may be sine pigmento) and exfoliation of malignant tumour cells into the tear film. Herein we present a case of eyelid melanoma arising in a patient previously treated for CM at a non-contiguous site and provide a comprehensive review of the relevant literature.
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Affiliation(s)
- Kelsey A Roelofs
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom
| | | | - Victoria M L Cohen
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom.,NIHR Biomedical Research Centre, UCL Institute of Ophthalmology, London, United Kingdom
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9
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Jakobiec FA, Cortes Barrantes P, Aronow ME. Relationship between Conjunctival Intraepithelial Dendritic Melanocytes and Nevocytes. Ocul Oncol Pathol 2020; 6:251-258. [PMID: 33005614 DOI: 10.1159/000505492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/16/2019] [Indexed: 11/19/2022] Open
Abstract
A 52-year-old male presented with a perilimbal-epibulbar, flat, pigmented lesion of 7 months' duration. Microscopic evaluation disclosed a proliferation of intraepithelial dendritic melanocytes without frank atypia, a lesion formerly termed "primary acquired melanosis." Within the lesion there were also intraepithelial basal junctional nevocytic nests and occasional small subepithelial nevocytic clusters which were positive for MART-1, HMB-45, and SOX-10 and negative for Ki-67. This remarkable lesion was suggestive of dendritic melanocytes transforming into rounded nevocytes lacking dendrites. The embryologic and biologic implications of these findings are explored, notably in regard to the unusual acquisition in mature adults of common nevomelanocytic nevi.
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Affiliation(s)
- Frederick A Jakobiec
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear/Harvard Medical School, Boston, Massachusetts, USA
| | - Paula Cortes Barrantes
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear/Harvard Medical School, Boston, Massachusetts, USA
| | - Mary E Aronow
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear/Harvard Medical School, Boston, Massachusetts, USA
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Abstract
Conjunctival melanoma is a rare malignant condition of the ocular surface. It is potentially lethal, with regional lymph node spread often preceding distant solid-organ metastasis. Due to its rarity and the long latency between treatment and local recurrence or the development of metastases, it is difficult to study. The literature is composed entirely of case series of varying quality, and there is significant variability in the management of this condition. This commentary attempts to distil the evidence base to provide practical management tips for the clinician.
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Affiliation(s)
- Victoria M L Cohen
- Ocular Oncology Service, Moorfields Eye Hospital and St Bartholomew's Hospital, London, UK.
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital, University College London Institute of Ophthalmology, London, UK.
| | - Roderick F O'Day
- Ocular Oncology Service, Moorfields Eye Hospital and St Bartholomew's Hospital, London, UK
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Pacheco GE, Garcia-Onrubia L, Garcia-Alvarez C, Muñoz MF, Garcia-Lagarto E, Perez DM, Alonso P, Saornil MA. A retrospective review of conjunctival melanoma: Presentation, treatment and evolution. Arch Soc Esp Oftalmol (Engl Ed) 2019; 94:218-224. [PMID: 30846247 DOI: 10.1016/j.oftal.2019.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The purpose of the present study is to describe the clinical characteristics and outcomes of patients diagnosed and treated for conjunctival melanoma in the Ocular Oncology Unit of the University Hospital Clinic of Valladolid. METHODS A retrospective observational case series study was conducted on patients diagnosed with conjunctival melanoma in the Ocular Oncology Unit of University Hospital Clinic of Valladolid, from January 1992 to December 2017. Demographic information and tumour features were recorded in a Microsoft Access database. RESULTS Among a total of 462 consecutive patients, the tumour was classified as melanocytic in 252 cases (54.5%), with 27 patients having the pathological diagnosis of conjunctival melanoma. The mean age at diagnosis was 59.2years (16-88), and there were 41% males and 59% females, with a mean follow-up of 6.1±6.8years. As regards the origin of conjunctival melanoma, 16 cases (59%) arose from primary acquired melanosis, 26% from nevus, and 15% developed de novo. The treatment performed was incisional or excisional biopsy in all patients, local adjuvant chemotherapy in 15 cases (56%) and brachytherapy in 5 patients (18%). The median survival was 18years and the probability of survival at 5 and 10years was 89% and 69%, respectively. CONCLUSIONS Conjunctival melanoma is a rare disease, usually undervalued by the patient as well as being underdiagnosed, leading to insufficient and delayed treatment. Early diagnosis and treatment are essential to prevent recurrences and systemic extension, as well as to preserve vision and life.
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Affiliation(s)
- G E Pacheco
- Unidad de Tumores del Adulto, Servicio de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - L Garcia-Onrubia
- Unidad de Tumores del Adulto, Servicio de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - C Garcia-Alvarez
- Unidad de Tumores del Adulto, Servicio de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M F Muñoz
- Unidad de Tumores del Adulto, Unidad de Investigación, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - E Garcia-Lagarto
- Servicio de Patología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - D M Perez
- Servicio de Oncología Radioterápica, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - P Alonso
- Servicio de Oncología Radioterápica, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M A Saornil
- Unidad de Tumores del Adulto, Servicio de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, España
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Chaparro Tapias TA, Díaz Díaz AL, Secondi R, Coy Villamil H, Sánchez España JC. Resolution of conjunctival melanoma with topical interferon alpha 2b in a patient with mitomycin C intolerance. ACTA ACUST UNITED AC 2018; 93:558-561. [PMID: 30072188 DOI: 10.1016/j.oftal.2018.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 05/29/2018] [Accepted: 06/04/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe the clinical and histological resolution of a case of an inexcisable conjunctival melanoma using topical interferon alpha 2b (INFα2b) in a patient with mitomycin C (MMC) intolerance. CASE REPORT Conjunctival melanoma is a rare, but potentially sight- and life-threatening, tumour. In cases of multiple lesions, or when surgical excision is not possible, topical combination chemotherapy with MMC and INFα2b has been described as first line therapy. The case is presented of a 77 year-old woman with a multifocal conjunctival in situ melanoma, who was intolerant to initial treatment with MMC and was switched to long-term INFα2b therapy, with a good outcome. CONCLUSIONS When topical MMC is given as chemotherapy treatment for primary acquired melanosis with atypia or in situ melanoma is not well tolerated, switching to INFα2b seems to be a good option. This approach could replace surgical management of pigmented tumours, especially the larger ones, with potential benefits that include less dependence on surgical margins. This report prompts a need for prospective studies designed to examine the role of INFα2b as primary treatment for heavily pigmented conjunctival tumours avoiding the ocular surface toxicity caused by MMC.
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Affiliation(s)
- T A Chaparro Tapias
- Fundación Oftalmológica de Santander (FOSCAL), Cirugía plástica ocular, oncológica y órbita, Bucaramanga, Colombia
| | - A L Díaz Díaz
- Fundación Oftalmológica de Santander (FOSCAL), Cirugía plástica ocular, oncológica y órbita, Bucaramanga, Colombia
| | - R Secondi
- Departamento de Oftalmología, Sapienza Universidad, Roma, Italia.
| | - H Coy Villamil
- Fundación Oftalmológica de Santander (FOSCAL), Cirugía plástica ocular, oncológica y órbita, Bucaramanga, Colombia
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Reddy HS, Keene CD, Chang SH, Jian-Amadi A, Cimino PJ. Immunohistochemical profiling including beta-catenin in conjunctival melanocytic lesions. Exp Mol Pathol 2017; 102:198-202. [PMID: 28161440 DOI: 10.1016/j.yexmp.2017.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 01/28/2017] [Indexed: 01/11/2023]
Abstract
Conjunctival melanocytic lesions encompass a group of clinically diverse, benign to malignant, neoplasms that may contain overlapping histopathological features, making definitive diagnosis challenging in some cases. In this series, we compared multiple immunohistochemical (IHC) markers in 11 conjunctival nevi, 10 primary acquired melanosis (PAM) lesions, and 11 conjunctival melanomas. Immunostains included the melanocytic markers HMB-45 and Melan-A, as well as the proliferative marker Ki-67. Loss of beta-catenin expression has been associated with more aggressive clinical disease in cutaneous melanoma, but its status in conjunctival melanocytic lesions is not known, therefore we incorporated beta-catenin immunohistochemical staining in our study. In this series, conjunctival melanomas had a higher Ki-67 proliferative index and HMB-45 immunoreactivity than did PAM lesions and conjunctival nevi (P<0.001). Melan-A was highly expressed in all 3 groups. Beta-catenin was more strongly expressed in melanomas and nevi than in PAM (P<0.001). There was high inter-grader reliability (Kappa=0.53). Overall, IHC labeling of HMB-45 and Ki-67 is increased in conjunctival melanomas compared to PAM or conjunctival nevi. Beta-catenin, an IHC marker previously unstudied in conjunctival melanocytic lesions, is not preferentially expressed in benign lesions and may play a different role in conjunctival atypia than it does in cutaneous melanoma.
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Affiliation(s)
- Harsha S Reddy
- Ophthalmic Plastic and Reconstructive Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, United States
| | - C Dirk Keene
- Department of Ophthalmology, University of Washington School of Medicine and Harborview Medical Center, Seattle, WA, United States; Department of Pathology, Division of Neuropathology, University of Washington School of Medicine and Harborview Medical Center, Seattle, WA, United States
| | - Shu H Chang
- Department of Ophthalmology, University of Washington School of Medicine and Harborview Medical Center, Seattle, WA, United States
| | - Arash Jian-Amadi
- Department of Ophthalmology, University of Washington School of Medicine and Harborview Medical Center, Seattle, WA, United States
| | - Patrick J Cimino
- Department of Pathology, Division of Neuropathology, University of Washington School of Medicine and Harborview Medical Center, Seattle, WA, United States.
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Mor JM, Heindl LM. Systemic BRAF/MEK Inhibitors as a Potential Treatment Option in Metastatic Conjunctival Melanoma. Ocul Oncol Pathol 2016; 3:133-141. [PMID: 28868285 DOI: 10.1159/000452473] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 10/12/2016] [Indexed: 12/17/2022] Open
Abstract
AIM In this review, we outline similarities between conjunctival and skin melanoma as well as the effectiveness of combined BRAF/MEK inhibition in melanoma, and discuss the applicability of these agents in conjunctival melanoma. METHODS The study provides a PubMed literature review. RESULTS Conjunctival melanoma and skin melanoma are genetically and phenotypically related. Both tumors typically harbor BRAF mutations in more than 50% of cases. New targeted therapies in metastatic skin melanoma include selective inhibition of BRAF and MEK. Combined BRAF/MEK inhibition has revolutionized the treatment of metastatic skin melanoma, significantly improving patients' prognoses. While these new substances have been investigated extensively in the treatment of skin melanoma, comparable studies in conjunctival melanoma do not exist owing to the rarity of the malignancy. CONCLUSIONS The application of combined BRAF/MEK inhibition in metastatic or unresectable conjunctival melanoma shows great potential for improving patients' prognoses. Future studies are needed to investigate the assumed benefit.
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Affiliation(s)
- Joel M Mor
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Cologne, Germany
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Albreiki DH, Gilberg SM, Farmer JP. Conjunctival malignant melanoma: A rare variant and review of important diagnostic and therapeutic considerations. Saudi J Ophthalmol 2012; 26:151-6. [PMID: 23960986 DOI: 10.1016/j.sjopt.2012.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Malignant melanoma of the conjunctiva is a relatively infrequent neoplasm that can be associated with significant morbidity and cause diagnostic difficulty to both the ophthalmologist and pathologist. We herein describe the first reported case in North American and European databases of a rare variant-signet ring cell melanoma - arising in the background of primary acquired melanosis (PAM) and use this case as a review of important diagnostic and therapeutic considerations when faced with this condition.
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