Results of surgical and radiation treatment of conjunctival melanoma

Abstract

Objective – analysis of the results of surgical and conservative treatment of conjunctival melanoma (CM) on the basis of our own experience. Materials and methods. Retrospective analysis of 25 patients with CM treated with surgery and/or Sr-90-brachytherapy in Ocular Oncology Service of S.N. Fyodorov Eye Microsurgery Federal State Institution. Clinical and histological features and treatment outcomes were analyzed. Results. Patients mean age was 57.15 years (from 20 to 82). In 9 cases CM arose from acquired melanosis (primary — 8, secondary — 1). In 15 cases tumor involved limbus, in 14 — cornea, in 24 cases — bulbar conjunctiva, in 8 — fornices and in 7 — tarsal conjunctiva. Maximum tumor thickness was up to 28 mm. Ten patients were treated with excisional biopsy (including CO2 -laser or radiosurgery), 4 — with excisional biopsy with subsequent Sr-90-brachytherapy, 8 — with brachytherapy alone with mean irradiation dose 150 Gy to a depth of 1.5–3.0mm, in 1 patient orbital periosteal exenteration was fulfilled and in 2 patients extended enucleation was performed. Seven excised tumors were epithelioid cell, 5 — spindle cell, 5 — mixed cell type. The follow-up was from 3 to 114 months (mean 25 months). Local control was achieved in 21 cases, 1 recurrence was after surgery and 3 after irradiation, all the recurrences were in patients with acquired melanosis, 3 recurrences were successfully treated, one led to exenteration. No recurrences were diagnosed after surgery combined with brachytherapy. One patient had preauricular limph nodes metastasis. Two patients died because of metastasis. No complications were diagnosed after Sr-90-irradiation. Patients underwent extended enucleation are followed up 4 and 22 months with no features of recurrences. Conclusion. Excisional biopsy especially combining with Sr-90-brachytherapy is a well-tolerated and effective therapy. Larger groups of patient are required for further analysis.