Malignant epibulbar melanoma: natural history and treatment by radiotherapy.

Abstract

SUMMARY One hundred and eighty-four cases of malignant melanoma of the lids and epibulbar region were seen in the Radiotherapy Department of the Royal Marsden Hospital during the period 1943-74. Some of these tumours were radiosensitive and could thus be treated by radiotherapy without loss of the affected eye. Their clinical and histological features are described. The treatment policy adopted was based on radiotherapy first, and surgery reserved for the failures. A policy of observation is advised for precancerous melanosis, and active treatment should be undertaken only if malignancy supervenes. The contraindications for radiotherapy, the factors governing radiosensitivity, and the incidence and site of metastases are reported, and the possible effect on the metastatic and survival rates of leaving the eye are discussed. Active treatment of the node-free neck is not advised. Results are given according to site, histology, and treatment method, and the frequency with which the eye was lost is shown, since the sole advantage of radiotherapy over surgery is the possibility of saving the eye without worsening the prognosis for survival.Histological studies largely undertaken in the past decade have greatly increased our knowledge of the cutaneous malignant melanoma. This tumour, which hitherto appeared to be both incomprehensible histogenetically and unpredictable in behaviour, has as a result become more understandable, though much still remains to be discovered. Unfortunately the conclusions drawn by dermatopathologists are not generally accepted by ophthalmic pathologists, and the pathology and treatment of conjunctival malignant melanoma still present unresolved problems, which have been admirably surveyed by Jacobiec. ' Despite advances made in the knowledge of the natural history of malignant melanoma there is still no general agreement on a treatment policy. Surgery understandably dominates treatment, but this dominance is largely based on fear and the laudable desire to rid the patient promptly of a tumour of evil repute. Meanwhile the therapeutic value of radiotherapy remains disputed, the malignant melanoma being customarily regarded as a radioresistant tumour and radiotherapy therefore held to be useless, if not harmful. It must be conceded that the history of radiotherapy in ophthalmology is an unhappy one. The early attempts to use radiant energy in the treatment of eye diseases were so calamitous that its use in the neighbourhood of the eye is regarded with trepidation to this day. However, with modern equipment and an adequate knowledge of the effects and risks of irradiating the eye it is possible to irradiate malignant tumours of the lids and epib;ulbar region without gross damage and still leave a useful functioning eye. The reluctance of ophthalmologists to use radiotherapy as an alternative to surgery in the treatment of epibulbar malignant melanoma is amply borne out by the infrequency with which this method receives, other than cursory or unfavourable, mention in ophthalmic literature. In th...

An audit of conjunctival melanoma treatment in Liverpool

“…3,4 Local excision with adjunctive radiotherapy or radiotherapy alone was reported by Treacher Collins in 1917 and by others but has not gained widespread acceptance. [5][6][7][8][9][10][11][12][13] Cryotherapy was popularised by Jakobiec in the 1980s and still has its advocates. [14][15][16] Treatment with a topical caustic agent was reported in 1893.…”

Use of a biosynthetic material to repair the surgical defect following excision of an epibulbar melanoma in a cat

“…Melanocytic tumors are the most common form of intraocular neoplasm in small animals. In cats, however, the majority of ocular melanomas arise from melanocytes in the uveal tract, rather than from limbal melanocytes 1–23 . Limbal melanomas, although rare, are usually benign in behavior and frequently warrant no more than monitoring, but have been occasionally reported to exhibit malignant tendencies especially in cats 8,10,11,13–16,19–21 …”

Malignant melanoma of the conjunctiva

“…There is still disagreement about their histological classification and considerable variation in management in different centres (Silvers et af. 1978, Jacobiec 1980, Lederman, Wybar & Busby 1984. For these reasons, we have conducted a retrospective study of a series of malignant melanomas of the conjunctiva seen in Manchester and Glasgow, to provide information about the clinical course and pathological features of this disease in patients living mainly in north-west England and south-west Scotland.…”