Patterns of regional head and neck lymph node metastasis in primary conjunctival malignant melanoma

Objective: To correlate patterns of regional lymph node metastasis with the site of origin in primary conjunctival malignant melanoma. Design: Retrospective analysis (1990-2003) of clinical data. Setting: Two London tertiary referral centres. Participants: 12 patients presenting with regional metastases after failed local treatment for conjunctival malignant melanoma. Results: 6 cases predominantly involving the temporal conjunctiva metastasised to the pre-auricular lymph nodes. Two cases predominantly involving the nasal conjunctiva metastasised to the submandibular nodes. Of the two cases with purely multifocal disease, one metastasised to the pre-auricular nodes and another to both submandibular and parotid nodes. One primary conjunctival malignant melanoma had its origin in temporal conjunctiva but metastasised to submandibular nodes, and another case originating from nasal conjunctiva metastasised to pre-auricular nodes. Conclusions: Temporal conjunctival melanotic lesions tend to metastasise clinically to pre-auricular lymph nodes and nasal conjunctival melanotic lesions metastasise to the submandibular lymph nodes. Patterns appear consistent with laboratory-based anatomically mapped lymphatic drainage basins of the conjunctiva.