Orbital exenteration in 95 cases of primary conjunctival malignant melanoma.

Abstract

The role of orbital exenteration in the management of malignant melanoma of the conjunctiva has been underexplored. The

Survival after malignant tumors of the orbit and periorbit treated by exenteration

“…It has been shown that tumors thicker than 1.0 mm are associated with a mortality varying between 33% and 50%. In contrast, when the tumor was less than 1.0 mm there was no mortality (Paridaens et al 1994). In our work, all patients had free margins and only the two patients operated with enlarged exenteration did not develop local recurrence or metastasis, suggesting that large excision is a key to success.…”

Conjunctival melanoma and melanocytic intra-epithelial neoplasia

“…27 Paridaens et al 30 have suggested that this is only palliative, not having any effect on survival.…”

“…8,27,39,41 Clinical risk factors include: disease recurrence, involvement of non-bulbar conjunctiva, medial bulbar conjunctiva, caruncle and plica semilunaris, and tumour thickness of more than 2 mm. 23,27,30,35,39,42 Clinically, CoMs are staged according to the 7th edition of TNM system developed by the AJCC and the International Union for Cancer Control (UICC). 7 Poor prognostic histopathological features comprise high mitotic count, presence of epithelioid cells, diffuse intraepithelial disease, extravascular matrix pattern, lymphatic invasion/microvascular density, lymphocytic/macrophage infiltration, and surface ulceration.…”

Malignant Melanoma of the Conjunctiva

“…In advanced cases (eg, deeply invasive and multifocal tumors), exenteration of the orbital contents may be the only option,although by this stage systemic spread of the tumor has frequently occurred, resulting in no effect on the prognosis for survival. 37 Others have advocated irradiation therapy as an alternative to exenteration for excellent local control and cosmesis. 38 In patients with extensive and multifocal neoplasia, cryotherapy has decreased the risk of local recurrence after surgical excision of nodular tumors.…”

“…41 Some centers have successfully utilized radiation therapy in the form of brachytherapy with iodine, strontium, or ruthenium plaques, or with external beam or proton beam irradiation. 37,42,43 More recently, topical chemotherapy with mitomycin C has been used to eradicate the atypical melanocytes in cases with extensive PAM with atypia ( Fig 2). [44][45][46] A combination of surgical excision of nodular tumors with cryotherapy to the underside of the adjacent conjunctival margins, localized alcohol corneal epitheliectomy in the areas of corneal pigmentation, and postoperative topical mitomycin C have been recommended for the management of extensive cases with invasive disease.…”