Melanoma of the conjunctiva

Conjunctival melanoma accounts for approximately 2% of ocular malignancies.

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Symptoms of conjunctival melanoma

Conjunctival melanoma presents in the 6th decade of life, excluding patients with dysplastic nevus syndrome, in whom multiple melanomas develop much earlier. There is a single, black or gray nodule containing a feeding vessel, which may be fixed to the episclera. Non-pigmented, pink tumors have a characteristic smooth appearance, resembling a "salmon fillet". The tumor is most often located in the limbus, although it can occur anywhere on the conjunctiva.

Differential diagnosis of conjunctival melanoma

• A large nevus that grows during puberty, but unlike melanoma, it does not affect the cornea.
• Ciliary body melanoma with extraocular extension.
• Melanocytoma is a rare, congenital, slow-growing, almost black tumor that does not move freely within the eyeball.
• Pigmented conjunctival carcinoma in dark-skinned individuals.

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Classification of conjunctival melanoma

• Melanoma as a result of the degeneration of PPM with atypical features accounts for 75% of cases.
• Melanoma as a result of malignization of a previously existing nevus accounts for 20% of cases.
• Primary melanoma is the least common.

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Treatment of conjunctival melanoma

Treatment of limited conjunctival melanoma

1. Surgical wide excision with cryotherapy to reduce the risk of recurrence.
2. If histological examination indicates incomplete removal, wide re-excision of the surgical scar within healthy tissue with subsequent cryotherapy is indicated.

Follow-up examinations are every 6-12 months throughout life. At each visit, the entire conjunctival surface is examined. Each suspicious area is examined histologically after taking a biopsy or impression cytology.

Treatment of diffuse conjunctival melanoma

Excision of nodules is performed in combination with cryotherapy and mitomycin C applications.

Relapses: resection and radiation therapy. Evisceration does not improve survival rates, so it is only performed in cases of extensive and progressive spread of the disease, when other methods cannot be used.

Lymph node involvement is treated with surgery (excision) and radiation therapy.

Palliative treatment for metastasis: chemotherapy.

Prognosis of conjunctival melanoma

Mortality (approximate): 12% of cases within 5 years and 25% within 10 years. The main sites of metastasis are regional lymph nodes, lungs, brain and liver.

Signs that indicate a poor prognosis for conjunctival melanoma include:

• Multifocal tumors.
• Extralimbal tumors involving the caruncle, fornix, or palpebral conjunctiva.
• Tumor density is 2 mm or more.
• Relapse.
• Spread to other tissues of the eye and lymph nodes.