Nasal and Orbital Recurrence of Conjunctival Melanoma 21 Years After Exenteration

Abstract

In our experience 5% of invasive malignant melanomas of the conjunctiva arising from areas ofprimary acquired melanosis with atypia spread to the ipsilateral nasal cavity and paranasal sinuses. Twenty one years after orbital exenteration for multicentric conjunctival melanoma an 82-year-old man was seen with an orbital recurrence, which had extended to the nasal cavity and paranasal sinuses through the nasolacrimal duct without invading the mucosa. This previously undescribed way of spread after the longest symptom-free interval following exenteration ever reported is illustrated. In 1985 a small, hard subcutaneous nodule, which was tethered to the periosteum superiorly in the right socket, was noted. The overlying skin was slightly pigmented. On observation the small mass remained unchanged.In 1990, 21 years after the exenteration, the 82-year-old patient complained of obstruction of the right nasal passage. Examination of the right orbit showed a large subcutaneous swelling at the medial edge of the right socket and the preexisting small nodule at the superolateral edge (Fig 1). Examination of the nasal cavity revealed a large ulcerating pigmented polyp obstructing the right nasal passage (Fig 2). There was no clinical involvement ofthe regional lymph nodes. Investigation for metastases, including liver ultrasound, liver function tests, and a chest x ray, was negative. There was no evidence of cutaneous malignant melanoma. A computerised tomography (CT) scan (Fig 3) showed the presence of tumour in the right anteromedial orbit, the nasolacrimal duct, invasion of the anterior ethmoidal cells, and a large intranasal mass. A diagnostic biopsy of the nasal lesion confirmed the clinical diagnosis of malignant melanoma. The patient's remaining eye showed lens opacities and age-related macular disease, reducing the visual acuity to 6/12.The patient was treated by right lateral rhinotomy. The skin overlying the medial orbital mass was excised. The anteromedial wall of the maxilla and the orbital floor were removed, and subsequently the tumour was cleared from the

Conjunctival Malignant Melanoma in Children

“…Prognostic factors are localization, cell type, infiltration of the lymphatics and tumor height [8]. Comparable studies on prognostic factors of these tumors show comparable results [1,7,9,10].…”

“…Statistical analysis concerns skin tumors only [4]. Conjunctival malignant melanomas are mainly presented in the form of case studies [3,[5][6][7].…”