Prognostic value of clinical and histopathological parameters in conjunctival melanomas: a retrospective study

Abstract

Aim: To determine prognostic factors for recurrence of disease and tumour related mortality in patients with conjunctival melanoma. Methods: A retrospective analysis of clinical and histopathological data of 69 patients with histologically verified conjunctival melanoma. Results: As univariate analysis showed, significant risk factors for the development of recurrence were: irregular pigmentation (RR = 2.0, p = 0.0007), incomplete surgical excision (RR = 3.5, p = 0.008), tumour invasion deeper than in substantia propria (RR = 3.9, p = 0.008), and presence of epithelioid tumour cells (RR = 2.9, p = 0.05). For tumour related mortality a significantly increased risk was found for tumour location in palpebral conjunctiva, caruncle, plica, or fornices (RR = 5.9, p = 0.001), for tumour infiltration deeper than the substantia propria (RR = 5.5, p = 0.001), for incomplete surgical excision (RR = 4.4, p = 0.05), and for nodular or mixed (nodular and superficial) growth pattern of the tumours (RR = 1.2, p = 0.002). The use of an adjuvant therapy for the surgical excision of the melanomas had no statistically significant influence upon the development of recurrent disease nor upon the tumour related mortality. Conclusion: These data present similar clinical and histopathological risk factors for patients with conjunctival melanoma as reported previously. The present study also addresses the failure of retrospective studies on conjunctival melanoma to prove the efficacy of a supplementary therapy to surgical excision.

Conjunctival melanoma and melanocytic intra-epithelial neoplasia

“…5,27 Local tumour recurrence is reported to occur in more than 50% of these cases. 23,38,39 Risk factors for recurrence are reported to be: multifocal disease, non-limbal position of the tumour, involvement of the surgical margin, and surgical excision without adjunctive treatment. 27,40 Our rates of recurrence are only 1.5% at a median of 2.2 years for patients treated primarily at our centre and 1.9% at a median 1.6 years (range 0-6.98) for salvage therapy for patients who initially had surgery elsewhere.…”

“…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.…”

“…4,27,43 There is compelling circumstantial evidence correlating local-tumour recurrence with metastasis. 8,27,39,41 In 45-60% of cases, the first site for metastasis is the regional lymph nodes, developing after a median of 2.3 years. 44 Systemic disease most commonly involves lungs, brain, liver, skin, bones, and gastrointestinal tract, and is typically detected at a median of 3.4 years.…”

Prognostication in eye cancer: the latest tumor, node, metastasis classification and beyond

“…Clinical prognostication Institution- 42,43 and populationbased [44][45][46] retrospective studies have consistently shown that the location and size of the primary conjunctival melanoma are strong and independent predictors of prognosis. Primary tumours located at the limbus, their most common site, or displaced to the cornea 47 carry a better prognosis than tumours in the bulbar, caruncular, and palpebral conjunctiva.…”

Malignant Melanoma of the Conjunctiva

“…1,5,16,[53][54][55][56][57] Prognostic factors include clinical features, with tumor location and extent being of major importance. Patients with multifocal tumors, orbital invasion, recurrent disease, and involvement of the caruncle, plica semilunaris, eyelid margins, and the palpebral and forniceal conjunctiva have a worse prognosis for survival.…”