Conjunctival melanoma treatment outcomes in 288 patients: a multicentre international data-sharing study

Abstract

BackgroundTo relate conjunctival melanoma characteristics to local control.MethodsRetrospective, registry-based interventional study with data gathered from 10 ophthalmic oncology centres from 9 countries on 4 continents. Conjunctival melanoma patients diagnosed between January 2001 and December 2013 were enrolled in the study. Primary treatments included local excision, excision with cryotherapy and exenteration. Adjuvant treatments included topical chemotherapy, brachytherapy, proton and external beam radiotherapy (EBRT). Cumulative 5-year and 10-year Kaplan-Meier local recurrence rates were related to clinical and pathological T-categories of the eighth edition of the American Joint Committee on Cancer (AJCC) staging system.Results288 patients had a mean initial age of 59.7±16.8 years. Clinical T-categories (cT) were cT1 (n=218,75.7%), cT2 (n=34, 11.8%), cT3 (n=15, 5.2%), cTx (n=21,7.3%) with no cT4. Primary treatment included local excision (n=161/288, 55.9%) followed by excision biopsy with cryotherapy (n=108/288, 37.5%) and exenteration (n=5/288, 1.7%). Adjuvant therapies included topical mitomycin (n=107/288, 37.1%), plaque-brachytherapy (n=55/288, 19.1%), proton-beam (n=36/288, 13.5%), topical interferon (n=20/288, 6.9%) and EBRT (n=15/288, 5.2%). Secondary exenteration was performed (n=11/283, 3.9%). Local recurrence was noted in 19.1% (median=3.6 years). Cumulative local recurrence was 5.4% (3.2–8.9%), 19.3% (14.4–25.5%) and 36.9% (26.5–49.9%) at 1, 5 and 10 years, respectively. cT3 and cT2 tumors were twice as likely to recur than cT1 tumours, but only cT3 had statistically significantly greater risk of local recurrence than T1 (p=0.013). Factors such as tumour ulceration, plica or caruncle involvement and tumour thickness were not significantly associated with an increased risk of local recurrence.ConclusionThis multicentre international study showed that eighth edition of AJCC tumour staging was related to the risk of local recurrence of conjunctival melanoma after treatment. The 10-year cumulative local recurrence remains high despite current management.

Structural Protein Analysis of Driver Gene Mutations in Conjunctival Melanoma

“…Wide excision with a "no touch technique" in combination with cryotherapy is the modern approach for managing CM [1,[6][7][8][9][10][11]. Limitations of this technique include the concern for extensive insult to the ocular surface with excisional biopsy and the potential for residual neoplastic cells.…”

Diagnostic Algorithm for Conjunctival Melanocytic Lesions

“…Patients with initial lymph node metastases have better prognosis than those initially presenting with systemic metastases (1). Conjunctival melanoma also has a high recurrence tendency (19-45% within 5 years, 26-59% within 10 years and 65% within 15 years of follow-up) (2,4,7,(12)(13)(14)(15). The median interval of recurrence varies between 11 and 17 months (4,(12)(13)(14)(15).…”

“…Conjunctival melanoma also has a high recurrence tendency (19-45% within 5 years, 26-59% within 10 years and 65% within 15 years of follow-up) (2,4,7,(12)(13)(14)(15). The median interval of recurrence varies between 11 and 17 months (4,(12)(13)(14)(15). A poorer prognosis (higher rates of recurrence and metastases), apart from a non-bulbar tumour location, the presence of mitotic figures, epithelioid cells, lymphatic or vascular invasion, and tumour lymphangiogenesis in the histopathological examination, are typical of tumours with a thickness greater than 0.5 mm and with ulceration (1,4,8,9,14).…”

“…The median interval of recurrence varies between 11 and 17 months (4,(12)(13)(14)(15). A poorer prognosis (higher rates of recurrence and metastases), apart from a non-bulbar tumour location, the presence of mitotic figures, epithelioid cells, lymphatic or vascular invasion, and tumour lymphangiogenesis in the histopathological examination, are typical of tumours with a thickness greater than 0.5 mm and with ulceration (1,4,8,9,14). Therefore, it is essential to recognise CMM precursors at an early stage.…”

“…Early stages of CMM, consisting especially of flat lesions, often pose diagnostic challenges, because at that time they share some features with benign mucosal lesions. As an incisional diagnostic biopsy of CMM may increase the risk of local recurrence of the tumour, it is necessary to search for diagnostic algorithms which would facilitate quicker diagnostics, particularly of small cancer lesions (2,14). The objective of our paper was to generate a diagnostic algorithm, which would differentiate between melanomas and other melanocytic conjunctival infiltrations.…”