Korean J Ophthalmol.  2005 Jun;19(2):91-95. 10.3341/kjo.2005.19.2.91.

Clinical Follow-up of Conjunctival Malignant Melanoma

• Choi J
• Kim M
• Park HS
• Lee SY

• KMID: 754403
• DOI: http://doi.org/10.3341/kjo.2005.19.2.91

Abstract

PURPOSE
To investigate the clinical features and course of conjunctival malignant melanoma in Korea. METHODS: The medical records of 15 patients, 5 males and 10 females, diagnosed with conjunctival malignant melanoma who had been treated at Severance Hospital from May 1991 to March 2004 were reviewed retrospectively. The clinical parameters of the patients, tumors, and treatment were analyzed for their relation to outcome measures. RESULTS: The mean age at the time of diagnosis was 53.4 years (+/-11.7 years). In all cases, the disease was unilateral and all patients had experienced at least one recurrence. Local lymph node metastasis was found in 3 patients (20%) and the mean time to metastasis was 3.5 years. Systemic metastasis was found in 6 patients (40%) and the mean time to metastasis was 9.3 years. There were 5 cases of tumor-related death (33.3%), 4 of which were attributed to systemic metastasis. The Kaplan-Meier estimates of cumulative survival rate were 90% at 30 months and 56.6% at 70 months. CONCLUSIONS: Although conjunctival malignant melanoma is a rare disease, it is life-threatening and complete tumor excision at an early stage is mandatory, as is additional therapy to prevent local recurrence and systemic metastasis.

Keyword

Conjunctival malignant melanoma; Metastasis; Recurrence

MeSH Terms

Adult
Conjunctival Neoplasms/mortality/*pathology/*physiopathology
Female
Humans
*Lymphatic Metastasis
Male
Melanoma/mortality/*physiopathology/*secondary
Middle Aged
*Neoplasm Recurrence, Local
Retrospective Studies
Survival Analysis
Time Factors

Figure

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  Fig. 1 Kaplan-Meier estimates of survival in 15 consecutive patients with conjunctival malignant melanoma.

Reference

1. Scott J, Fraumeni JF, Lee JA. Melanomas of the eye and other noncutaneous sites: epidemiologic aspects. J Natl Cancer Inst. 1976. 56:489–491.

2. Seregard S, Koch E. Conjunctival malignant melanoma in Sweden 1969-91. Acta Ophthalmol. 1992. 70:289–296.

3. Kong YT, Kwak YJ, Kim JC, Song DJ. A case of malignant melanoma of conjunctiva. J Korean Ophthalmol Soc. 1984. 25:235–237.

4. Folberg R, McLean IW, Zimmerman LE. Malignant melanoma of the conjunctiva. Hum Pathol. 1985. 16:136–143.

5. Norregaard JC, Gerner N, Jensen OA, Prause JU. Malignant melanoma of the conjunctiva: occurrence and survival following surgery and radiotherapy in a Danish population. Graefes Arch Clin Exp Ophthalmol. 1996. 234:569–572.

6. Werschnik C, Lommatzsch PK. Long-term follow-up of patients with conjunctival melanoma. Am J Clin Oncol (CCT). 2002. 25:248–255.

7. Paridaens ADA, Minassian DC, McCartney ACE, Hungerford JL. Prognostic factors in primary malignant melanoma of the conjunctiva: a clinocopathological study of 256 cases. Br J Ophthalmol. 1994. 78:252–259.

8. Shields CL, Shields JA, Gunduz K, et al. Conjunctival melanoma: risk factors for recurrence, exenteration, metastasis and death in 150 consecutive patients. Arch Ophthalmol. 2000. 118:1497–1507.

9. Anastassiou G, Heiligenhaus A, Bechrakis N, et al. Prognostic value of clinical and histopathological parameters in conjunctival melanomas: a retrospective study. Br J Ophthalmol. 2002. 86:163–167.

10. Paridaens ADA, McCartney ACE, Minassian DC, Hungerford JL. Orbital exenteration in 95 cases of conjunctival malignant melanoma. Br J Ophthalmol. 1994. 78:520–528.

11. Shields JA, Shield CL, DePotter P. Surgical approach to conjunctival tumors: The 1994 Lynn B. McMahan Lecture. Arch Ophthalmol. 1997. 115:808–815.

12. DePotter P, Shields CL, Shields JA, et al. Clinical predictive factors for development of recurrence and metastasis in conjunctival melanoma: a review of 68 cases. Br J Ophthalmol. 1993. 77:624–630.

13. Paridaens D, Beekhius H, Bosh W, et al. Amniotic membrane transplantation in the management of conjunctival melanoma and primary acquired melanosis with atypia. Br J Ophthalmol. 2001. 85:658–661.

14. Espana EM, Prabhasawat P, Grueterich M, et al. Amniotic membrane transplantation for reconstruction after large ocular surface neoplasm. Br J Ophthalmol. 2002. 86:640–645.

15. Lederman M, Wybar K, Busby E. Malignant epibulbar melanoma: natural history and treatment by radiotherapy. Br J Ophthalmol. 1984. 68:605–617.

16. Finger PT, Milner MS, McCormick SA. Topical chemotherapy for conjunctival melanoma. Br J Ophthalmol. 1993. 77:751–753.

17. Esmaeli B. Advances in the management of malignant tumors of the eyelid and conjunctiva : the role of sentinel lymph node biopsy. Int Ophthalmol Clin. 2002. 42:151–162.

18. Amato M, Esmaeli B, Ahmadi MA, et al. Feasibility of preoperative lymphoscintigraphy for identification of sentinel lymph nodes in patients with conjunctival and periocular skin malignancies. Ophthal Plast Reconstr Surg. 2003. 19:102–106.

19. Park CS, Son JH, Chung WS, Cho IH. Lymphoscintigraphy of eyeball and ocular adnexal malignant tumors. J Korean Ophthalmol Soc. 2004. 45:893–898.

20. Seppo T, Tero K. Metastatic pattern and survival in disseminated conjunctival melanoma. Ophthalmology. 2004. 111:816–821.

21. Kirkwood J, Strawderman M, Ernstoff M, et al. Interferonalpha-2b adjuvant therapy of high-risk resected cutaneous melanoma: the Eastern Cooperative Oncology Group Trial EST 1684. J Clin Oncol. 1996. 14:7–17.

22. Buzaid AC, Colome M, Bedikian A, et al. Phase II study of neoadjuvant concurrent biochemotherapy in melanoma patients with local-regional metastases. Melanoma Res. 1998. 8:549–556.

23. Eton O, East M, Legha SS, et al. Pilot study of intra-arterial cisplatin and intravenous vinblastine and dacarbazine in patients with melanoma in-transit metastases. Melanoma Res. 1999. 9:483–489.

24. Lommatzsch PK, Lommatzsch RE, Kirsch I, Furman P. Therapeutic outcome of patients suffering from malignant melanoma of the conjunctiva. Br J Ophthalmol. 1990. 74:615–619.