Retrospective study of combined treatments for conjunctival melanoma

Abstract

AbstractPurpose Since 2OOO, we have been using proton beam therapy after surgery for all invasive conjunctival melanomas. Patients with associated primary acquired melanosis also receive additional treatment with mitmycin 0, 04% drops at least two cycles. We have made a retrospective study to evaluate the results.Methods Patients were sent to Curie Institute for initial treatment, after the initial surgery or for recurrence. Surgery was performed under general anesthesia; proton beam was applied only on the area of invasive melanoma with a dose of 60 grays in 8 fractions. Results concerning the initial findings, the treatment and the follow up were prospectively registered.Results 62 patients were treated, 36 for initial treatment and 26 after surgery performed elsewhere. The median follow up is 24 months.(range 7 to 146 months) Median tumor diameter was 8 mm, with a thickness < 2mm for 33, > 2mm for 22 patients. TNM and histology will be described. Surgical excision was considered complete in 21 cases. All patients received proton beam irradiation and 25 received mitomycin drops. 10 patients (16%) presented local recurrence and 4 patients (6%) developed metastatic disease.Conclusion : Because of direct contact with the sclera, invasive conjunctival melanoma cannot be removed with sufficient margin if the eye is not removed. The use of proton beam therapy immediately after surgery allows good ocular preservation with very low rate of local recurrence .The prognostic of patients with primary acquired melanosis with atypia has been improved by the use of preventive treatment of the conjunctiva by mitomycin before invasive melanoma occurs.