Prognosis of conjunctival melanomas in relation to histopathological features

Abstract

Summary Twenty-six patients (age 29-85 years) with primary malignant melanoma of the conjunctiva were analysed for usefulness of various histopathological and immunohistochemical features of the primary, recurrent and metastatic tumours in evaluating their prognosis. The mean follow-up time was 5.5 years, ranging from 8 months to 17 years. Eight patients developed metastases and seven have died. The mean time from diagnosis to death due to metastasis was 3.8 years (range 1-6 years). The site of the primary tumour seemed to be most closely correlated to high metastatic risk. Only two of the sixteen limbal melanomas metastasised, whereas two of the four bulbar, all three tarsal and the only diffuse primary tumour caused metastatic disease. Two of the metastasising primary tumours were less than 1.5mm thick, but all exceeded 0.8mm in thickness. The mitotic rate, the amount of inflammatory infiltrate, the cell type or the presence of adjacent intraepithelial involvement did not obviously correlate to treatment outcome. Furthermore, the expression of S-100 protein and neuron-specific enolase (NSE), both suggested to be prognostic indicators in cutaneous melanoma, did not correlate to the tendency of the conjunctival melanomas to recur or metastasise.

Malignant Melanoma of the Conjunctiva

“…Patients with multifocal tumors, orbital invasion, recurrent disease, and involvement of the caruncle, plica semilunaris, eyelid margins, and the palpebral and forniceal conjunctiva have a worse prognosis for survival. 1,5,16,[53][54][55][56][57] The mortality rate has been shown to be approximately equal in patients with conjunctival melanoma in association with and without PAM with atypia. 13,16 Histopathologic findings associated with a poor prognosis include a tumor thickness of greater than 0.8 mm (in contrast to 1.5 mm or 2 mm in different studies) and involvement of the surgical margin.…”

“…13,16 Histopathologic findings associated with a poor prognosis include a tumor thickness of greater than 0.8 mm (in contrast to 1.5 mm or 2 mm in different studies) and involvement of the surgical margin. 1,5,12,16,[53][54][55][56][57] Findings indicating poor prognosis include presence of a dominant pagetoid or melanoma in situ growth pattern, PAM sine pigmento, lymphatic or vascular invasion, presence of epithelioid cells, and 5 or more mitoses per 10 high-power fields. 5,8,16 Patients with in-transit metastases (regional periocular metastases), which may be identified clinically (Fig 9) and confirmed histologically, also have a poor prognosis, with the subsequent development of systemic metastases in most of these cases.…”

“…1,5,16,[53][54][55][56][57] Prognostic factors include clinical features, with tumor location and extent being of major importance. Patients with multifocal tumors, orbital invasion, recurrent disease, and involvement of the caruncle, plica semilunaris, eyelid margins, and the palpebral and forniceal conjunctiva have a worse prognosis for survival.…”

DNA ploidy and S-phase fraction as prognostic factors in patients with uveal melanomas

“…In earlier studies prognostic variables such as age, tumour size, location, invasion into the sclera or optic nerve, blind eye, cell type, rupture of Bruch's membrane and extrascleral extension of the tumour were found to predict survival in patients with uveal melanomas (Callender et al, 1941;Raivio, 1977;Affeldt et al, 1980;Pach et al, 1986;Hungerford, 1989;Gamel et al, 1992). To some extent this was also the case with conjunctival melanomas (Fuchs et al, 1989).…”

“…In earlier studies prognostic variables such as age, tumour size, location, invasion into the sclera or optic nerve, blind eye, cell type, rupture of Bruch's membrane and extrascleral extension of the tumour were found to predict survival in patients with uveal melanomas (Callender et al, 1941; Raivio, 1977;Affeldt et al, 1980;Pach et al, 1986;Hungerford, 1989;Gamel et al, 1992). To some extent this was also the case with conjunctival melanomas (Fuchs et al, 1989 entered, McLean and Gamel (1988) found that the chi-square value for DNA amount in the cell dropped to a nonsignificant level. Rennie et al (1989) measured the sum of S and G2/M phases in 19 fresh uveal melanomas and found for diploid tumours that spindle cell neoplasms had lower cell turnover rates than epithelioid cells.…”