Lack of tumour pigmentation in conjunctival melanoma is associated with light iris colour and worse prognosis

Brouwer, Niels J.; Marinković, Marina; Luyten, Gregorius P M; Shields, Carol L.; Jager, Martine J.

doi:10.1136/bjophthalmol-2018-312018

Cited by 17 publications

(11 citation statements)

References 27 publications

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“…As reported in our earlier study of a predominantly Caucasian population with CoM, 60% of all primary lesions were of high pigmentation and 40% were of low pigmentation [10]. This is significantly different from the percentages found in recurrent lesions of the same study population: 46 patients (39%) had exclusively pigmented lesions during follow-up, and 71 patients (61%) had non-pigmented or mixed lesions at some moment during follow-up.…”

Section: Discussioncontrasting

confidence: 69%

“…A data set of 444 patients diagnosed with primary CoM from the Wills Eye Hospital (Philadelphia, USA) and the Leiden University Medical Center (Leiden, The Netherlands) was analysed. Patient and tumour characteristics of this combined set have been previously published [10]. In short, all patients had histopathologically confirmed CoM, the mean age of these patients was 59.5 years (SD 17.5), 51% was female, the mean tumour thickness was 1.77 mm (SD 2.1) and 63% of lesions were epibulbar.…”

Section: Methodsmentioning

confidence: 99%

“…'pigmented') or 'low pigmentation' (i.e. 'non-pigmented/mixed'), based on the patient medical file and available clinical photographs [10]. Mixed lesions were categorised together with nonpigmented lesions as apparently parts of the lesion lost the ability to produce pigment.…”

Section: Methodsmentioning

confidence: 99%

“…To identify which mechanisms play a role in melanoma development and the formation of metastases, we recently studied tumour pigmentation in primary CoM [10]. A light tumour pigmentation was associated with a higher frequency of recurrences (HR 1.63, p = 0.043), metastases (HR 2.48, p = 0.004) and melanoma-related deaths (HR 2.60, p = 0.014).…”

Section: Introductionmentioning

confidence: 99%

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Pigmentation of conjunctival melanoma recurrences and outcome

Brouwer

Marinković

Luyten

et al. 2019

Graefes Arch Clin Exp Ophthalmol

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Purpose In primary conjunctival melanoma (CoM), one of the characteristics that is associated with an increased risk of metastases and death is a lack of tumour pigmentation. The aim of this study was to investigate whether the degree of pigmentation of CoM recurrences relates similarly to clinical outcome. Methods A data set of 177 patients with a CoM recurrence from the Wills Eye Hospital (USA) and the Leiden University Medical Center (The Netherlands) was analysed. The relation between clinical tumour pigmentation of the recurrences, the characteristics of the primary lesions and clinical outcome was investigated. Results In 117 (66%) of 177 patients with a CoM recurrence, tumour pigmentation was known: 71 patients (61%) had recurrences with low pigmentation. Primary lesions had low pigmentation in 39% of cases, which is significantly different (p = 0.001). However, low tumour pigmentation of recurrences correlated with low tumour pigmentation of the primary lesion (p < 0.001). No association was observed between pigmentation of the recurrences and iris colour (p = 0.66). Low pigmentation of the recurrences was not significantly associated with an increased risk for metastases (HR 1.96, p = 0.12) or death (HR 1.79, p = 0.27), whereas primary tumours with low pigmentation did show a greater risk for metastases (HR 2.82, p = 0.016) and death (HR 2.90, p = 0.037). Conclusions CoM recurrences are more often lightly pigmented compared to primary lesions. A correlation exists between the degree of pigmentation of primary and recurrent lesions, but recurrences can appear with any degree of pigmentation. Unlike primary CoM, the level of pigmentation of CoM recurrences is not related to metastasis or death.

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Section: Discussioncontrasting

confidence: 69%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pigmentation of conjunctival melanoma recurrences and outcome

Brouwer

Marinković

Luyten

et al. 2019

Graefes Arch Clin Exp Ophthalmol

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“…Recent studies showed that low-pigmented CM is seen more frequently in eyes with light iris color and is associated with a higher rate of recurrences, distant metastases and death. Thus, it has been hypothesized that a low tumor pigmentation is associated with worse outcomes (17), with a possible link between eumelanin/pheomelanin ratio and the grade of severity of CM. It is possible, however, that worse outcomes occur in pale tumours because they mimic other entities such as OSSN and definitive management is delayed.…”

Section: Discussionmentioning

confidence: 99%

Invasive conjunctival melanoma mimicking ocular surface squamous neoplasia: a case series

et al. 2020

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BackgroundConjunctival melanoma is the second most common conjunctival malignant tumour after squamous cell carcinoma, usually arising from primary acquired melanosis and less commonly from a conjunctival naevus or de novo. We report four cases of conjunctival melanoma masquerading as ocular surface squamous neoplasia.MethodsFour patients (2 females and 2 males; mean age 60.7 years; range 41–72 years) were referred for suspicious conjunctival lesions. In all cases, the lesions had a perilimbal location, were non-pigmented (cases 1 and 3) or mildly pigmented (cases 2 and 4), had a fleshy (cases 1, 2 and 4) or papillomatous (case 3) appearance and involved the corneal surface. In each case, our main clinical differential diagnosis included conjunctival intraepithelial neoplasia and squamous cell carcinoma. All four patients underwent an excisional biopsy with double freeze-thaw cryotherapy and alcohol keratoepitheliectomy.ResultsIn all four cases, the histopathological diagnosis was of invasive conjunctival melanoma with extension to the deep surgical margins. Adjuvant therapy consisting of strontium-90 β radiotherapy (all 4 patients) and topical Mitomicyn C (patient 2) was administered.ConclusionConjunctival melanoma can clinically resemble ocular surface squamous neoplasia. Clinical impressions therefore need to be confirmed histopathologically.

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