Conjunctival Melanoma: Outcomes Based on Age at Presentation in 629 Patients at a Single Ocular Oncology Center

Dalvin, Lauren A; Yaghy, Antonio; Vaidya, Sarangdev; Pacheco, Richard R; Pérez, Alejandro; Lally, Sara E.; Shields, Jerry A.; Shields, Carol L.

doi:10.1097/ico.0000000000002449

Cited by 11 publications

(1 citation statement)

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“…45 Older patients tend to present with more extensive disease and have a higher risk for both loss of visual acuity and local recurrence. 49 Although cases have been reported in children, this occurrence is exceedingly rare. 50 CM most commonly arises in association with PAM/C-MIN/CMIL.…”

Section: Conjunctival Melanoma Clinical Featuresmentioning

confidence: 99%

Conjunctival Melanocytic Lesions

Bresler

Simon

Shields

et al. 2021

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Conjunctival melanocytic lesions consist of a variety of neoplastic and nonneoplastic conditions. These include benign processes such as primary intraepithelial hypermelanosis and melanocytic hyperplasia, secondary forms of intraepithelial hypermelanosis and melanocytic hyperplasia, melanocytic nevi, melanocytic proliferations with malignant potential, and melanoma. Objective.— To provide a concise yet comprehensive resource regarding the histopathologic diagnosis of conjunctival melanocytic lesions. We aim to detail and clarify the numerous classification schemes that exist for junctional melanocytic proliferations of the conjunctiva (known as primary acquired melanosis or PAM; also termed conjunctival melanocytic intraepithelial neoplasia or C-MIN). Although not uniformly adopted, C-MIN is classified by using a numeric system based on a defined set of criteria. A less complex scheme (conjunctival melanocytic intraepithelial lesion or CMIL) has recently been proposed by the World Health Organization. Additionally, we aim to update the reader regarding molecular features and prognostic indicators. Data Sources.— Peer-reviewed literature and archived cases for illustration. Conclusions.— Accurate histologic classification is essential, as PAM/C-MIN/CMILs that have a significant potential to progress to invasive melanoma may be clinically indistinguishable from low-risk lesions. Conjunctival melanoma (CM) more closely resembles cutaneous melanoma in terms of its pathogenesis and molecular features, compared to melanoma arising at other mucosal sites or to uveal melanoma. Depth of invasion and ulceration status, among other factors, have emerged as important prognostic indicators in CM. Sentinel lymph node biopsy may provide further prognostic information. Lastly, integration of pathologic and clinical findings is essential at this anatomically sensitive location to determine appropriate clinical management.

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Section: Conjunctival Melanoma Clinical Featuresmentioning

confidence: 99%

Conjunctival Melanocytic Lesions

Bresler

Simon

Shields

et al. 2021

Archives of Pathology &Amp; Laboratory Medicine

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Factors affecting recurrence and metastasis in conjunctival melanoma

Çalış Karanfil,

Gündüz,

Gündüz

et al. 2023

Int Ophthalmol

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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 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. Fifteen (33.3%) patients had conjunctival PAM; 2 (4.4%) patients had conjunctival nevus. The tumor stage was T1 in 24 (53.0%), T2 in 13 (29.0%), and T3 in 6 (13.0%) of the cases. For stage T1 and T2 CM, in addition to excisional biopsy (EB)and cryotherapy, alcohol epitheliectomy (AE) was performed in 17 cases (37.8%), super cial 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 (51.0%) of the excised tumors at histopathologic examination. Adjuvant topical mitomycin-C(MMC) was used in 7 (38.9%) and strontium-90 episcleral brachytherapy in 6 (33.3%) of the 23 cases with tumorpositive borders. During the follow-up, recurrence was seen in 14 (31.3%) cases. According to Kaplan Meier analysis, the mean time to recurrence development was 106.3±17.3 months and the 5-year survival rate was 52.0%. Fourteen of the recurrent cases underwent EB+ cryotherapy, 3 underwent AE+SS, and 3 underwent secondary exenteration. Metastasis and lymph node involvement occurred in 11 (25.0%) and 8 (18.2%) of the cases, respectively. Four (8.9%) cases expired. According to Kaplan-Meier analysis, the mean time to metastasis was 119.6±24.1 months and the 5-year survival rate was 52.0%. While recurrence was more frequent in melanomas developing from PAM/nevus, metastasis was more frequent in men and those with lymph node involvement.Conclusion: Conjunctival melanoma is 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 are risk factors for metastasis.

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