Treatment of conjunctival melanocytic neoplasms: the Liverpool experience

Abstract

Abstract Purpose To audit the results of treatment of conjunctival melanoma in Liverpool. Methods Patients treated between 1993 and 2006 were identified by searching the Ocular Oncology Service database and pathology archives. The casenotes were reviewed. Patients were included if their conjunctival tumour was histologically diagnosed as invasive melanoma. Tumour extent and location were defined using a mapping system we developed. During the course of this study, cryotherapy was abandoned in favour of topical chemotherapy for intra‐epithelial melanocytic neoplasia and brachytherapy for invasive disease. Results Forty patients with invasive conjunctival melanoma were initially treated at our centre and another 36 were referred to us for salvage therapy after a surgical intervention elsewhere (11 with no visible tumour, 9 with intra‐epithelial disease and 16 with invasive melanoma). The patients we initially treated all retained the eye, most without significant visual loss. Recurrence occurred in six patients, none of whom had adjunctive brachytherapy. Four patients died of metastasis, all with caruncular involvement. After salvage therapy in 16 patients referred with recurrent or persistent invasive disease, two eyes were lost and five patients died, only one of whom had caruncular involvement. Conclusion Excision of invasive conjunctival melanoma with adjunctive brachytherapy and topical chemotherapy achieved high rates of local tumour control with little ocular morbidity. Without caruncular involvement, disease‐specific mortality was rare unless the patient was referred with invasive disease after a surgical procedure elsewhere. Our results suggest that inexpert surgical intervention increases the risk of local tumour recurrence and metastatic death.