Malignant tumors of the conjunctiva and cornea

[1], [2], [3], [4],

Squamous cell carcinoma of the conjunctiva and cornea

Scaly cell carcinoma of the conjunctiva and cornea is rarely observed. The provoking factors include ultraviolet radiation, human papillomatous virus and HIV infection. More often the tumor is diagnosed in persons older than 50 years. It can be located in any part of the conjunctiva. The first signs of the disease are local hyperemia and conjunctival thickening. A tumor can have the appearance of a papillomatous whitish-pink node and even a whitish pterygium in combination with elements of inflammation. Its boundaries are indistinct, on the surface, in the tumor nipples, there are clearly visible chaotically located tender own vessels. The tumor is characterized by a rather slow growth. Its aggressiveness is due to invasion into deep-lying tissues, destruction of the cornea, sclera, and germination of tumor masses into the eye cavity. The choice of treatment is determined by the location and size of the tumor. For small tumors located on the limbus and cornea, the installation effect of mitomycin C according to a special scheme for 2 weeks gives a pronounced effect. A combination of local excision of the tumor with cryodestruction is possible. When the tumor is located outside the limbus and cornea, brachytherapy is shown in combination with local laser coagulation or electro excision, or a wide excision with simultaneous cryoapplication on the wound surface.

[5], [6], [7], [8], [9], [10], [11]

Conjunctival Melanoma

Conjunctival melanoma accounts for about 2% of all malignant tumors of the conjunctiva; it is more often diagnosed in the fifth or sixth decades of life, more often in men. The tumor develops from primary acquired melanosis (75%) and preexisting nevi (20%) or is primary (5%). Melanoma can be localized in any part of the conjunctiva, but more often (up to 70%) - on the conjunctiva of the eyeball. The tumor may be pigmented or non-pigmented, the latter for a long time asymptomatic; grows rapidly as a node or superficially; sometimes there are multiple foci that can merge. The surface of the melanoma is smooth and shiny. In the pigmented form, radially located pigment "tracks" or pigment deposits are visible on the node border. A network of dilated, congestive-full blood vessels is formed around the tumor. As the melanoma grows, its surface becomes ulcerated, bleeding of the tumor appears. Characterized by the emergence of satellites as a result of the formation of screenings and contact with the main tumor site. Pigmentless screenings are especially dangerous, because the doctor often does not notice them because of the pink color. In half of the patients, melanoma grows into the cornea.

Tumor treatment should begin as early as possible. In localized melanoma, a combined organ-preserving treatment is indicated, local excision and brachytherapy, local chemotherapy with mitomycin C and local block excision (removal of the tumor from the surrounding healthy tissues) can be performed. With a common tumor, as well as with melanoma of the lacrimal meat and the lunate fold, radiation with a narrow medical proton beam is effective.

The prognosis for conjunctival melanoma is poor. With hematogenous metastasis, the mortality rate reaches 22-30%. With adequate treatment, 5-year survival is 95%. The outcome of treatment depends largely on the location and size of the tumor. For melanomas up to 1.5 mm thick, the prognosis is better. If the tumor thickness reaches 2 mm or more, the risk of regional and distant metastases increases. The prognosis worsens if the tumor spreads to the lacrimal meat, the arches and the palpebral conjunctiva. When epibulbar melanoma, especially localized in the area of the limbus, the prognosis is more favorable.

[12], [13], [14], [15]