Purpose: To elucidate the clinical features, current treatment status, and prognosis of conjunctival melanoma.
Subjects and methods: A retrospective medical chart review was conducted to examine patient background and clinical features of 50 patients diagnosed with conjunctival melanoma at Tokyo Medical University Hospital; and to investigate treatment, clinical course and prognosis of 45 patients treated in our hospital.
Results: The mean age at diagnosis was 65.7±15.1 (37-96) years; male/female ratio was 19/31; the right eye was affected in 23 patients and the left eye in 27 patients. All patients were Japanese. Fourteen cases were T1 (28%), 26 cases were T2 (52%), and 10 cases were T3 (20%) according to the TNM classification. Except for some not-evaluable cases, all evaluable cases were N0 and M0 at the initial visit. Conjunctival melanosis and nevus were observed in 42 cases (84%) and 9 cases (18%), respectively. Of the 45 patients who were treated in our hospital, 5 patients (11%) underwent orbital exenteration as initial treatment, and 40 patients (89%) underwent eye-sparing treatments as necessary, which consisted of cryotherapy and topical chemotherapy, along with tumor resection and conjunctival reconstruction. The mean follow-up period was 51.4±40.2 months (12-159 months). Thirteen (29%) of the 45 patients showed local recurrence. Among them, 2 patients required orbital exenteration after recurrence. The recurrence rate after initial treatment was 8.9% at 1 year, 19.3% at 3 years, and 35.6% at 5 years. Seven of the 45 cases (16%) developed lymph node and/or distant metastasis.
Conclusions: Clinical features of Japanese patients with conjunctival melanoma were elucidated. Eye-sparing treatments were used as initial treatment in nearly 90% of the patients, the recurrence rate was around 30%, and eyeball was ultimately preserved in more than 80% of the patients. Detailed analysis of prognostic factors over a long follow-up period is warranted.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 127: 7-18,2023.