Cases Of Conjunctival Melanoma Research Articles

Clinicopathologic features and survival outcomes of ocular melanoma: a series of 31 cases from a tertiary university hospital

BackgroundWe aimed to determine the effect of clinicopathologic features on overall survival among Caucasian ocular melanoma patients in the Central Anatolia region of Turkey.MethodsThis single-center study included conjunctival (n = 12) and uveal (n = 19) melanoma patients diagnosed between January 2008 and March 2020. Clinicopathologic features and outcomes were reviewed retrospectively. Five cases were tested for BRAF V600 mutations with real-time polymerase chain reaction, and one case was tested with next-generation sequencing. Survival was calculated using the Kaplan-Meier method.ResultsThirty-one patients had a mean initial age of 58.32 years (median, 61 years; range 25 to 78 years). There were 13 male and 18 female patients. The median follow-up time was 43.5 months (range, 6 to 155 months) for conjunctival melanoma and 35 months (range, 8 to 151 months) for uveal melanoma. When this study ended, eight of the 12 conjunctival melanoma patients (66.7%) and nine of the 19 uveal melanoma patients (47.4%) had died. The presence of tumor-infiltrating lymphocytes was related to improved overall survival in conjunctival melanoma (p = .014), whereas the presence of ulceration (p = .030), lymphovascular invasion (p = .051), tumor in the left eye (p = .012), tumor thickness of > 2 mm (p = .012), and mitotic count of >1/mm2 (p = .012) reduced the overall survival in conjunctival melanoma. Uveal melanoma tumors with the largest diameter of 9.1–15 mm led to the lowest overall survival among subgroups (p = .035). Involvement of the conjunctiva (p=.005) and lens (p = .003) diminished overall survival in uveal melanoma. BRAF V600 mutation was present in one case of conjunctival melanoma, GNAQ R183Q mutation was present in one case of uveal melanoma. Patients with uveal melanoma presented with an advanced pathological tumor stage compared to those with conjunctival melanoma (p = .019).ConclusionsThis study confirmed the presence of tumor-infiltrating lymphocytes as a favorable factor in conjunctival melanoma and conjunctival and lens involvement as unfavorable prognostic factors in uveal melanoma for overall survival, respectively.

Red Herrings and Zebras - a Curious Case of Conjunctival Melanoma

Red Herrings and Zebras - a Curious Case of Conjunctival Melanoma

Satellite in transit metastases in a case of loco‐regional metastatic conjunctival melanoma

AbstractPurposeTo report the clinical and histopathological findings of satellite in transit metastases in one case of conjunctival melanoma with cervical and parotid lymph node spreading.MethodsCase report of a patient initially examined at Institut Curie, Paris, on September 2018, with histopathological analysis, review of the literature and discussion.ResultsA 82 year‐old woman was referred for additional treatment after the removal of a 3mm thick pigmented infiltrating conjunctival melanoma in the temporal bulbar conjunctiva of the left eye. Proton beam irradiation was planned but finally declined by the patient. TEP‐CT was prescribed and revealed cervical and parotid lymph‐node infiltration, treated by external radiotherapy in another radiotherapy center. She was referred again 8 months later for local recurrences in the left conjunctiva. We observed 11 pigmented conjunctival nodules in the temporal and supero‐nasal quadrants. We surgically removed them and proton beam irradiation of the entire invaded area was planned. Histopathological analysis of some conjunctival nodules revealed well‐delimitated subepithelial nodules of melanoma cells. These nodules were extravascular and aligned along microvascular channels, suggesting angiotropism and extravascular migratory metastases.ConclusionAngiotropism and extravascular migration seem to be implicated in satellite in transit metastases in conjunctival melanoma. It has to be recognized as according to literature it could be a marker of rapid metastatic disease progression and death of the patient.

The predictive factor for conjunctival melanoma recurrence

Conjunctival melanoma potentially deadly tumor. While many cases of conjunctival melanoma appeared to be a recurrence, there is no valid data about parameters to predict the recurrence of this tumor. This study intended to evaluate whether histopathologic features can be used as a predictor for recurrence in conjunctival melanoma. This was a retrospective study, involving patients with conjunctival melanoma by the year 2013-1017 in Dr. Sardjito General Hospital and Dr. Yap Eye Hospital, Yogyakarta. Patient’s characteristic was determined by age, sex, laterality, tumor size, tumor location, histopathological dominancy, MMC application, recurrence, and metastases. Sixteen cases were found: male (62.5%) and female (37.5%). Age from 5-79 years, mean was 56.19 years. Tumor location was in bulbar in 11 patients (68.7%), palpebral in 5 patients (31.3%).There was significant association between metastasis and the tumor recurrence (OR 13.0; 95% CI 1.9-85.4; p = 0.007). A favorable trend of association was also found between location and the recurrence of melanoma (OR 15.0; 95% CI 0.9-228.8; p = 0.06). In summary, our study showed that the patients that developing distant metastasis were at a greater risk for tumor recurrence.

Conjunctival Melanoma in a Horse Treated by Tumor Resection and Cryotherapy

Background: Ocular melanoma is very rare compared to cutaneous melanoma in horses. Definitive diagnosis is made through histopathological examination and treatment options include surgical excision associated with cryotherapy, radiation therapy, and chemotherapy. In this report, we describe a case of conjunctival melanoma in a horse that has been treated successfully with surgical excision associated with cryotherapy.Case: A 15-year-old male Percheron male was referred to the Ophthalmology Veterinary Section of the Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil, with a history of a pigmented mass located on the lower eyelid of the left eye. Ophthalmologic examination revealed ocular discomfort, secretion and a pigmented mass in the left inferior bulbar conjunctiva. The dermatological examination revealed other melanomas in the perineal region. Complete blood count and serum chemistry profile were within normal ranges and prior to surgery the horse was treated with flunixin meglumine (1.1 mg/kg, IV, q 12 h). Sedation was performed with xylazine (0.4 mg/kg, IV) and detomidine hydrochloride(0.01 mg/kg, IV) and then the animal was placed in a retention trunk. The conjunctival mass was resected with a margin of safety. Liquid nitrogen was applied to the tumor site and the adjacent conjunctiva with a copper cryoprobe with one unit of liquid nitrogen. Histopathological examination revealed neoplastic cells containing pigmented melanocytes in the conjunctival submucosa, confirming the diagnosis of conjunctival melanoma. Postoperative treatment was performed with flunixin meglumine (1.1 mg/kg, IV, q 12 h) for 3 days and topical ophthalmic ointment containing neomycin, polymyxin B sulfate and dexamethasone twice daily for one week. Seven days after surgery, the lesion was healed. The patient was followed for 24 months after excision and there was no evidence of recurrence.Discussion: Older horses are considered more predisposed to melanoma development, possibly because of the proliferation of melanocytes as a manifestation of aging, and in addition, cutaneous melanomas are common in gray horses and rare in other horse colors. In this case, the horse was a 15-year-old Percheron horse with gray hair. In horses, there is only one case of conjunctival melanoma documented in the literature. In both cases, the ophthalmic examination revealed a large, raised, heavily pigmented mass protruding from the bulbar conjunctiva. The only difference is that in the present case the location of the mass was in the inferior bulbar conjunctiva and in the case cited in the literature. The mass was located in the bulbar conjunctiva under the lateral comer. In this case, the diagnosis of conjunctive melanoma was based on clinical signs and confirmed by histopathological examination. It was decided to perform an excisional biopsy for treatment and to confirm the diagnosis of conjunctival melanoma. The choice of treatment depends very much on the clinical presentation, that in this animal, despite the neoplasia being extended, it was located only in the conjunctiva without involvement of the sclera and the eyelid. Therefore the decision was made to perform an excisional biopsy associated with cryotherapy. The purpose of such adjuvant therapy is to kill all residual tumor cells and prevent the recurrence of malignant tumors. In the present case, the surgical wound was cured one week after surgery. The surgical procedure in the case reported was performed under local anesthesia and sedation with the horse standing. To make this decision, consideration should be given to patient health, anesthetic risk, and additional risks during recovery from general anesthesia. In this case, surgical excision of the mass associated with cryotherapy was effective in the treatment of conjunctival melanoma in a horse.Keywords: ocular, equine, melanocytic neoplasia, cryosurgery.

Long Term Outcome of Surgical Excision of Conjunctival Melanoma Combined with Mitomycin C Use: A Case Report

Purpose: To report a case of conjunctival melanoma (CM) treated with excision and adjuvant mitomycin C. Methods: This is a case report of a 51-year-old female with conjunctival melanotic lesion (10.5 × 5 mm), that was treated with complete surgical excision, combined with perioperative and intraoperative use of mitomycin C 0.02%. Lymphoscintigraphy with 0.3 mCi of technetium Tc-99m sulfur colloid and sentinel lymph node biopsy were also performed. Results: Histological and immunohistochemical staining of the excised melanotic lesion [S-100 (+), Melan (+), Tyrosinase (+), HMB 45 (+)] confirmed the clinical diagnosis of Conjunctival Melanoma. Moreover, lymphoscintigraphy and sentinel lymph node biopsy were negative for tumor metastasis. Ten years postoperatively, there were neither signs of tumor recurrence or metastasis nor late postoperative complications due to mitomycin C. Conclusions: Complete surgical excision combined with perioperative and intraoperative MMC 0.02% was safe and effective in preventing local recurrence in a case of conjunctival melanoma.

C-Kit SCF receptor (CD117) expression andKITgene mutation in conjunctival pigmented lesions

To investigate the presence of KIT gene mutations and immunoreactivity in 85 conjunctival melanocytic tumours and to clarify the role of KIT as a potential therapeutic target in this group of patients. Eighty-five conjunctival pigmented tumours [27 melanomas, 12 primary acquired melanosis (PAMs) and 46 nevi] were immunostained for KIT. Intensity and pattern of expression were evaluated. Molecular analysis to identify KIT mutations was performed in 15 selected cases (tumour-rich areas >50%). KIT immunostaining score and pattern were statistically related to patients' age, sex, diagnostic category, presence of relapse, disease-free survival, presence of metastases, metastasis-free survival, limbal versus nonlimbal tumour location and thickness of melanomas. KIT stains were documented in 48% of melanomas, 50% of PAMs and 24% of nevi. The mean score of KIT staining in the melanomas/PAMs group was significantly different from nevi (p = 0.0076). No statistically significant differences were detected between either c-kit immunostaining score or pattern and each of the other clinico-pathologic parameters considered. No KIT gene mutations were detected in melanomas and nevi. A silent mutation/polymorphism in KIT exon 13 was found in one PAM. Despite the high level of KIT immunostains in PAMs and melanomas, this parameter seems not to be a good predictor of the presence of molecular mutations. KIT-activating mutations should be considered an uncommon event in this tumour.

A case of conjunctival melanoma in a cat

Since 1985, 5 cases of feline conjunctival melanoma have been reported in the literature. Information on feline conjunctival melanoma epidemiological features, localizations, macroscopic features and histological features is limited. We are describing the clinical, histopathologic features and outcomes in a cat that presented clinically with a slow developing dark brown mass located under the upper eyelid of the left eye. Pertinent literature is reviewed; and the recognizable clinical features and treatment are discussed. The mass was surgically resected. Despite its size, the lesion was easily separated from underlying tissues, making possible a macroscopic complete resection that left intact the adjacent conjunctiva. The tumour histological examination has showed a pigmented melanoma lacking encapsulation, but presenting a clear zone delimiting the lesion. It was exclusively composed of epithelioid cells, and presented mild cellular anaplasia and weak mitotic activity. These features allowed it to be classified as a quite differentiated melanoma with few signs of potential malignancy. In accordance with these histologic features, no recurrence has been registered 34 months after surgery. Thus, a favorable outcome is now reported for two out of six cases of conjunctival melanoma in the cat. This report also confirms the predilection for this neoplasm to arise from the bulbar conjunctiva.

Tumor progression in ocular melanomas.

The term ocular melanoma refers to a heterogeneous group of cancers of melanocytic origin. The precursor of most cases of conjunctival melanoma is known to ophthalmologists as primary acquired melanosis. This condition passes through well-defined stages of tumor progression. Although tumor progression is not obligatory, as a conjunctival melanocytic lesion acquires new biologic properties it is more likely to progress further. Although junctional nevi are seldom encountered beyond childhood and primary acquired melanosis usually develops in middle-aged individuals, these two conditions may be histologically indistinguishable. Most junctional nevi eventually show evidence of differentiation, whereas nearly half of the cases of primary acquired melanosis with atypia progress to melanoma. Therefore, it is possible that aging may modulate the capability of certain clonal proliferations to differentiate. Uveal melanocytes normally reside in mesenchyme, so that the traditional histologic criterion for establishing the diagnosis of most melanomas--breach of an epithelial basement membrane--does not apply. Because uveal melanomas are not easily accessible to incisional biopsy (without disruption of vision), only two points in the spectrum of tumor progression are defined clinically: nevus and melanoma. Experimental evidence suggests that a spectrum of atypical melanocytic proliferations separates benign nevi from melanomas capable of generating metastases. Unlike conjunctival melanomas that spread first to regional lymph nodes, choroidal and ciliary body melanomas preferentially spread first to the liver and are examples of organ-specific metastases.

Tumor Progression in Ocular Melanomas

The term ocular melanoma refers to a heterogeneous group of cancers of melanocytic origin. The precursor of most cases of conjunctival melanoma is known to ophthalmologists as primary acquired melanosis. This condition passes through well-defined stages of tumor progression. Although tumor progression is not obligatory, as a conjunctival melanocytic lesion acquires new biologic properties it is more likely to progress further. Although junctional nevi are seldom encountered beyond childhood and primary acquired melanosis usually develops in middle-aged individuals, these two conditions may be histologically indistinguishable. Most junctional nevi eventually show evidence of differentiation, whereas nearly half of the cases of primary acquired melanosis with atypia progress to melanoma. Therefore, it is possible that aging may modulate the capability of certain clonal proliferations to differentiate. Uveal melanocytes normally reside in mesenchyme, so that the traditional histologic criterion for establishing the diagnosis of most melanomas--breach of an epithelial basement membrane--does not apply. Because uveal melanomas are not easily accessible to incisional biopsy (without disruption of vision), only two points in the spectrum of tumor progression are defined clinically: nevus and melanoma. Experimental evidence suggests that a spectrum of atypical melanocytic proliferations separates benign nevi from melanomas capable of generating metastases. Unlike conjunctival melanomas that spread first to regional lymph nodes, choroidal and ciliary body melanomas preferentially spread first to the liver and are examples of organ-specific metastases.

Steroids and neuroendocrine hormones detected by the immunoperoxidase technique from malignant melanomas and nevi of the choroid and conjunctiva.

By the peroxidase-antiperoxidase technique, the authors studied 7 malignant choroidal melanomas, 7 conjunctival nevi and 1 malignant conjunctival melanoma with the aim to detect the presence of vasoactive intestinal polypeptide (VIP), adrenocorticotropic hormone (ACTH), gastrin, estradiol and testosterone. Positive staining reaction for VIP, estradiol and testosterone was observed in both malignant melanomas of the choroid and conjunctival nevi. The case of conjunctival melanoma was positive for VIP and ACTH but not for estradiol and gastrin.

Immunofluorescent detection of antibodies to ocular melanomas.

Antitumor antibodies were detected in the sera of patients with uveal and conjunctival melanomas by the indirect immunofluorescent technique of tumor imprints. In 16 of 18 cases of primary choroidal melanoma, two cases of metastatic choroidal melanoma, and one case of late orbital recurrence, granular cytoplasmic fluorescence from labeled IgM antibodies was found. Immunoglobulin M antibodies were also found in two cases of iris melanoma and in two of three cases of conjunctival melanoma. Immunoglobulin G antibodies to tumor-associated antigens were found in three of nine cases of primary choroidal melanoma. Specificity of the reaction was established by absorption techniques, blocking studies, and the finding of no false positive results among control sera from 1,083 patients. The results imply that this serologic test may be a sensitive, nontraumatic diagnostic test for ocular melanomas.