Malignant melanoma of the conjunctiva: occurrence and survival following surgery and radiotherapy in a Danish population

Nørregaard, Jens Christian; Gerner, Neel; Jensen, O. A.; Prause, Jan Ulrik

doi:10.1007/bf00448801

Cited by 99 publications

(66 citation statements)

References 13 publications

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“…Clinical prognostication Institution- 42,43 and populationbased [44][45][46] retrospective studies have consistently shown that the location and size of the primary conjunctival melanoma are strong and independent predictors of prognosis. Primary tumours located at the limbus, their most common site, or displaced to the cornea 47 carry a better prognosis than tumours in the bulbar, caruncular, and palpebral conjunctiva.…”

Section: Prognosis Of the Primary Tumourmentioning

confidence: 99%

Prognostication in eye cancer: the latest tumor, node, metastasis classification and beyond

Kivelä

Kujala

2012

Eye

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The tumour, node, metastasis (TNM) classification is a universal cancer staging system, which has been used for five decades. The current seventh edition became effective in 2010 and covers six ophthalmic sites: eyelids, conjunctiva, uvea, retina, orbit, and lacrimal gland; and five cancer types: carcinoma, sarcoma, melanoma, retinoblastoma, and lymphoma. The TNM categories are based on the anatomic extent of the primary tumour (T), regional lymph node metastases (N), and systemic metastases (M). The T categories of ophthalmic cancers are based on the size of the primary tumour and any invasion of periocular structures. The anatomic category is used to determine the TNM stage that correlates with survival. Such staging is currently implemented only for carcinoma of the eyelid and melanoma of the uvea. The classification of ciliary body and choroidal melanoma is the only one based on clinical evidence so far: a database of 7369 patients analysed by the European Ophthalmic Oncology Group. It spans a prognosis from 96% 5-year survival for stage I to 97% 5-year mortality for stage IV. The most accurate criterion for prognostication in uveal melanoma is, however, analysis of chromosomal alterations and gene expression. When such data are available, the TNM stage may be used for further stratification. Prognosis in retinoblastoma is frequently assigned by using an international classification, which predicts conservation of the eye and vision, and an international staging separate from the TNM system, which predicts survival. The TNM cancer staging manual is a useful tool for all ophthalmologists managing eye cancer. Keywords: conjunctival malignancies; eyelid malignancies; orbital malignances; retinoblastoma; uveal melanomaThe tumour, node, metastasis (TNM) classification is a cancer staging system, which has been in worldwide use across all medical specialties for five decades. 1 It emerged in 1968 when the International Union Against Cancer published the first edition of its classification based on the anatomic extent of the tumour after testing a set of draft classifications for 23 cancer sites. None of these sites related to the eye.Indeed, eye cancer is a latecomer in the TNM classification, appearing for the first time in the fourth and fifth editions. 2 The first ophthalmic section covered six sites and five cancer types-carcinoma and melanoma of the eyelid and conjunctiva, melanoma of the uvea, retinoblastoma, sarcoma of the orbit, and carcinoma of the lacrimal gland-but these classifications were untested and were rarely used outside cancer registries.The ophthalmic section was revised for the sixth edition of TNM in 2002. 3 This edition was based on the published literature, but the classifications were not tested against clinical data. The revision received publicity 4 but did not make a breakthrough. Meanwhile, data were collected of other cancers to improve staging. For the updated TNM classification of cutaneous melanoma, data from over 20 000

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Section: Prognosis Of the Primary Tumourmentioning

confidence: 99%

Prognostication in eye cancer: the latest tumor, node, metastasis classification and beyond

Kivelä

Kujala

2012

Eye

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“…Notably, only one of our patients required exenteration, which has been necessary in up to 20% of patients in other studies. 15,32 Our patient requiring exenteration was referred in 1995 after treatment elsewhere and we had treated her with adjunctive cryotherapy, which we have since abandoned.…”

Section: Eyementioning

confidence: 99%

An audit of conjunctival melanoma treatment in Liverpool

Damato

Coupland

2008

Eye

116

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Purpose To evaluate treatment of conjunctival melanomas at the Ocular Oncology Service in Liverpool. Methods We included 40 patients initially treated at our centre for invasive conjunctival melanoma and 36 patients referred for salvage therapy after surgery elsewhere. Patients underwent local excision or radiotherapy. Adjunctive cryotherapy for invasive and intra-epithelial neoplasia was abandoned in favour of ruthenium brachytherapy and mitomycin C chemotherapy, respectively. Tumours were staged according to circumferential spread, basal diameter, and histological thickness. Results The 40 previously-untreated tumours were confined to bulbar conjunctiva in 31 patients and involved extrabulbar conjunctiva in 9, affecting caruncle in 6 of these. All eyes were conserved, most retaining initial visual acuity. Invasive conjunctival recurrence, which occurred in six patients, was more likely with medial tumours (Log-rank, P ¼ 0.004) and if treatment did not include radiotherapy (Logrank, P ¼ 0.03). Four patients died of metastases, all with caruncular involvement. Of the 36 patients referred for salvage therapy after previous surgery, 11 had no visible tumour, 9 had only intra-epithelial neoplasia, and 16 had invasive melanoma, which was recurrent in seven. After salvage therapy, five patients died, all of whom were referred with recurrent invasive tumour and only one of whom had caruncular involvement. Conclusions Excision of invasive melanoma with adjunctive brachytherapy and topical chemotherapy achieved high rates of local tumour control with little ocular morbidity. Without caruncular involvement, diseasespecific mortality was rare unless the patient was referred after a surgical procedure. Our results suggest that inadequate surgical intervention increases risks of local recurrence and metastatic death.

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“…Sua incidência vem aumentando nos Estados Unidos da América entre a população masculina (20,21) e em pacientes acima de 60 anos (21) . MC é mais frequente em indivíduos idosos com idade média va riando de 55 a 70 anos (6,18,19,(22)(23)(24)(25) . Embora raro em jovens, existem relatos de casos de MC em pacientes com menos de 20 anos de idade (26,27) .…”

Section: Incidênciaunclassified

“…Embora raro em jovens, existem relatos de casos de MC em pacientes com menos de 20 anos de idade (26,27) . Não existe diferença significativa entre o acometimento de homens e mulheres (6,18,19,(22)(23)(24)(25) .…”

Section: Incidênciaunclassified

Melanoma maligno conjuntival

Novais

Karp

2012

Arq. Bras. Oftalmol.

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Malignant melanoma of the conjunctiva: occurrence and survival following surgery and radiotherapy in a Danish population

Abstract: The results are estimated to represent a nationwide sample of patients. No prognostic factors of significance were identified.

Cited by 99 publications

References 13 publications

Prognostication in eye cancer: the latest tumor, node, metastasis classification and beyond

Prognostication in eye cancer: the latest tumor, node, metastasis classification and beyond

An audit of conjunctival melanoma treatment in Liverpool

Melanoma maligno conjuntival

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