Conjunctival Metastasis of a Cutaneous Melanoma

Abstract

Purpose: To report a patient who presented with a conjunctival tumour as a first sign of distant metastasis of cutaneous melanoma. The patient was treated successfully with BRAF/MEK-inhibitors and anti-PD-1 antibodies. Methods: Clinical and histopathological examination of the conjunctival lesion. Results: A 74-year-old man was referred to our hospital with a pigmented conjunctival tumour, 5 months after having been diagnosed with cutaneous melanoma on his right scapula with loco-regional axillary lymph node metastases. The conjunctival lesion was excised and showed a BRAF V600E mutation. Histopathology showed a melanoma with characteristics suspicious for metastasis, as the lesion did not have a relation with the overlying epithelium. Systemic screening showed multiple distant metastases of the cutaneous melanoma in spleen, liver, and bone. Systemic treatment with the combination of a BRAF-inhibitor (dabrafenib) and MEK-inhibitor (trametinib) was started and followed by a switch to an anti-PD-1 antibody (pembrolizumab). Twenty-two months later, the patient is alive and in good clinical health. Conclusion: Conjunctival metastases of cutaneous melanoma may mimic primary conjunctival melanoma. A good medical history and systemic work-up are required to differentiate these diseases. Identification of the proper diagnosis including mutation analysis is crucial, allowing patients to benefit from newly introduced treatment strategies for metastatic cutaneous melanoma.

Two Late Recurrences of Conjunctival Melanoma

“…Detection of a (secondary) cutaneous origin could be very relevant, as new treatments with targeted therapy (e.g., BRAF-inhibitors) have become available with potential benefit for selected patients [11]. Various cases have been reported of ocular presentation of disseminated cutaneous melanoma, which were successfully treated with these agents [12]. …”

Epibulbar Proliferative Fasciitis, a Variant of Nodular Fasciitis: A Differential Diagnosis of Conditions With Focal or Diffuse Myxoid Stromas

“…21 Individual case reports have underscored the primacy of breast carcinomas among conjunctival metastases and the wide range of other carcinomas that should be considered including uterine cervix , 66 gastric , 67 colonic , 68 renal , 69,70 lung , 71,72 and cutaneous melanoma . 73 A newly discovered confounding finding is that mucinous carcinomas 74 and secretory mammary carcinomas can arise primarily from the conjunctival epithelium. 75 Mucinous breast carcinomas can metastasize to ocular adnexa simulating the aforementioned primary tumors.…”

Conjunctival Melanoma with Ipsilateral, Non-Contiguous Eyelid Involvement: A Case Report and Comprehensive Review of the Literature

“…Rarely, abnormal conjunctival pigmentation mimicking primary CM can occur in patients with a prior diagnosis of cutaneous melanoma. Reports documenting conjunctival metastasis have included patients with cutaneous melanoma arising at both distant (trunk [22, 23], axilla [24], scapula [25], vaginal mucosa [26]) and local (pre-auricular [27], temple [28], neck [29]) sites. Conversely, there have been rare reports of primary CM metastasizing to the eyebrow and cheek [30]; however, it is unclear whether or not the histopathological findings in these patients were consistent with in-transit metastasis or not.…”