Recurrent malignant melanoma of the corneal stroma: a case of 'black cornea'.

Abstract

A 39-year-old Caucasian woman with a history of recurrent conjunctival melanoma of her right eye developed an intrastromal heavily pigmented malignant melanoma, which involved the whole corneal diameter. The patient was treated by corneoscleral lamellar keratoplasty and there has been no evidence of recurrent neoplasm during 4 years of foliowup. This apparently unique presentation of malignant melanoma ofthe cornea is illustrated and the differential diagnosis of corneal pigmentation is discussed.Malignant melanoma of the cornea is very uncommon. Though primary corneal melanoma has been reported'"5 this neoplasm is usually seen in association with an adjacent limbal or conjunctival melanocytic lesion. We describe a patient with a history of recurrent conjunctival melanoma who presented with a black cornea due to extensive malignant melanocytic invasion into corneal stroma.

Advances in the management of conjunctival melanoma

“…Local invasion into the cornea has also been reported, usually superficial to Bowman membrane, but occasionally deeper in the stroma. [98, 112, 136, 141] Intraocular extension is rare but may occur after incomplete surgical excision. [148]…”

Prognostic factors in primary malignant melanoma of the conjunctiva: a clinicopathological study of 256 cases.

“…One patient had been given 15 group is 2-0 (range 1-13 biopsies). Sixty two patients (24 2%) received a combination of cryotherapy and radiotherapy, 40 (15-6%) received radiotherapy as only adjuvant therapy, seven (2 7%) were given cryotherapy as the only adjuvant therapy, while the other 147 (57 4%) received no adjuvant therapy: 36 (14-1%) patients were managed by primary exenteration of the diseased orbit, while 59 (23-1%) underwent orbital exenteration as a secondary procedure.…”

Brown cornea

“…It is a typical feature of racial pigmentation [7]. Primary corneal melanoma does exist [14], and it may be caused by invasion of the corneal stroma of tumour cells from adjacent conjunctival, ciliary body, and iris melanoma [10] or from acquired conjunctival melanosis with atypia [8,9,12]. Corneal pigmentation is frequently due to trauma and drug side effects [4], and may also rarely be caused by migration of iris melanocytes covering the Descemet's membrane [2,5,11,13].…”

“…However, a brown corneal pigmentation is very rare in humans. A pigmented corneal lesion may be due to side effects from drugs (for example epinephrine, iron, silver), foreign bodies or tattooing, melanocytic migration in heavily pigmented individuals, migration of nevus cells or ochronosis [4,8,9]. We describe a patient with a history of corneal stromal pigmentation who presented with a brown cornea due to an extensive, progressive pigmentation of the corneal midstroma, causing reduced visual acuity.…”