Data from long-term follow-up examinations of patients with conjunctival melanoma are limited. A retrospective study of survival rates and local tumor relapse rates was performed on 85 patients initially treated between 1958 and 1993. Therapeutic procedures were local excision, local excision followed by brachytherapy, local excision combined with cryotherapy, and local excision followed by either irradiation or cryotherapy and adjuvant mitomycin C (MMC) application. The Kaplan-Meier method was used to estimate cumulative survival rates and event rate curves. Clinical parameters of the patients and the tumors were obtained and analyzed for their relation to tumor recurrence and death from metastatic melanoma using the multivariate Cox hazards modeling. The median follow-up duration among the surviving patients was 13.1 years (mean 13.8 years). The cumulative 10-year survival rate of the 85 patients based on all causes of death was 62.5%, and that based on tumor-related death was 77.7%. Patient age greater than 55 years, higher TNM category, and unfavorable tumor location (palpebral conjunctiva, fornix, caruncle, corneal stroma, eyelid) were identified as prognostic factors for death from metastatic melanoma. Tumors with unfavorable location, higher TNM grade, and excision alone as initial therapy showed a higher cumulative probability of local relapse than favorably located (bulbar and limbal conjunctiva) tumors, lower TNM grade, and excision plus adjuvant therapy. The behavior of conjunctival melanomas remains unpredictable in individual cases. To minimize local recurrence rate surgical excision should be combined with an adjunctive procedure such as irradiation, cryotherapy, or local chemotherapy with MMC. Randomized prospective multicentric studies are required.

Although a high proportion of treated eyes eventually lost a great deal of vision, and although many treated eyes ultimately underwent secondary enucleation, a substantial number of patients treated by plaque radiotherapy in this series survived for well over 10 years and retained the tumor-containing eye with a visual decrease of varying severity.

SUMMARY From 1964 to 1984 309 patients with choroidal melanoma were treated with. "'Ru/"'Rh Pi ray applicators (1000 Gy at the apex of the tumour within 7-14 days). In 216 cases (69-9%) this treatment was successful for a mean follow-up period of 6.7 years after irradiation. In 53 cases (17.2%) the eye had to be enucleated, and 40 patients (12.9%) died from metastases within this period. Of the 216 successfully treated patients 114 (52-8%) developed flat scars and 49 (22-7%) retained a visual acuity of 1-5-0-5. Radiogenic late complications with damage to the retinal capillary system were the main causes of visual deterioration, especially in eyes with tumours close to the posterior pole. The survival rate is substantially higher than that for patients whose eyes were primarily enucleated. Ray applicators with "'Ru/I"Rh can be recommended as an effective tool and a simple and cheap procedure to cure patients with small and medium sized choroidal melanomas. They save the eye without endangering our patients' lives.