4.6 Article

Invasive conjunctival melanoma mimicking ocular surface squamous neoplasia: a case series

Journal

BRITISH JOURNAL OF OPHTHALMOLOGY
Volume 105, Issue 6, Pages 775-778

Publisher

BMJ PUBLISHING GROUP
DOI: 10.1136/bjophthalmol-2019-315393

Keywords

Conjunctiva; tumour; ocular surface squamous neoplasia

Categories

Funding

  1. National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology

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This study reported four cases of conjunctival melanoma masquerading as ocular surface squamous neoplasia, highlighting the clinical resemblance between conjunctival melanoma and ocular surface squamous neoplasia and the importance of confirming clinical impressions histopathologically.
Background Conjunctival melanoma is the second most common conjunctival malignant tumour after squamous cell carcinoma, usually arising from primary acquired melanosis and less commonly from a conjunctival naevus or de novo. We report four cases of conjunctival melanoma masquerading as ocular surface squamous neoplasia. Methods Four patients (2 females and 2 males; mean age 60.7 years; range 41-72 years) were referred for suspicious conjunctival lesions. In all cases, the lesions had a perilimbal location, were non-pigmented (cases 1 and 3) or mildly pigmented (cases 2 and 4), had a fleshy (cases 1, 2 and 4) or papillomatous (case 3) appearance and involved the corneal surface. In each case, our main clinical differential diagnosis included conjunctival intraepithelial neoplasia and squamous cell carcinoma. All four patients underwent an excisional biopsy with double freeze-thaw cryotherapy and alcohol keratoepitheliectomy. Results In all four cases, the histopathological diagnosis was of invasive conjunctival melanoma with extension to the deep surgical margins. Adjuvant therapy consisting of strontium-90 beta radiotherapy (all 4 patients) and topical Mitomicyn C (patient 2) was administered. Conclusion Conjunctival melanoma can clinically resemble ocular surface squamous neoplasia. Clinical impressions therefore need to be confirmed histopathologically.

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