Surgical specimen handling for conjunctival melanoma: Implications for local control, tumor thickness, and sentinel lymph node biopsy

Abstract

7564 Background: To evaluate conjunctival melanoma surgical specimens for their ability to provide reliable information about margins of resection and tumor thickness. Methods: The excisional biopsy specimens for 23 patients with a diagnosis of bulbar or palpebral conjunctival melanoma, treated at the University of Texas M. D. Anderson Cancer Center between January of 2000 and June 2004, were reviewed. The ability to evaluate margins of resection and tumor thickness were specifically studied in these specimens. Results: Five out of the 23 specimens were found to have been cut tangentially; thus eliminating the possibility of tumor thickness determination. In all 23 specimens, the margins of resection were positive on the original biopsy specimen and in each case additional surgery was required after the initial excision and upon subsequent referral to our hospital. Conclusions: Tangential cutting of the conjunctival specimens is a frequently encountered problem and may eliminate the pathologist’s ability to comment on tumor thickness. The majority of excisional biopsies for suspected conjunctival melanoma are indeed found to have positive margins. Tumor thickness has been shown to be one of the most important predictors for regional lymph node metastasis and survival for conjunctival melanomas. With the advent of sentinel lymph node biopsy as an optional staging procedure, loss of ability to comment on tumor thickness eliminates appropriate patient selection for this procedure. Careful orientation of the biopsy specimens for suspected conjunctival melanoma is crucial to allow for adequate assessment of tumor thickness and margins of resection. No significant financial relationships to disclose.