eMedicine Specialties > Ophthalmology > Conjunctiva

Melanoma, Conjunctival: Follow-up

Author: Manolette R Roque, MD, MBA, DPBO, FPAO, President and CEO, Chief of Service, Ocular Immunology and Uveitis, Consulting Staff, Cornea and Refractive Surgery, Eye Republic Ophthalmology Clinic; General Manager, Ophthalmic Consultants Philippines Co; Consulting Staff, CME Liaison, Section Chief of Ocular Immunology and Uveitis, Department of Ophthalmology, Asian Hospital and Medical Center
Coauthor(s): Barbara L Roque, MD, Full Partner, Ophthalmic Consultants Philippines Co, Chief of Service, Pediatric Ophthalmology and Strabismus, Consulting Staff, Orbit and Eye Plastics, EYE REPUBLIC Ophthalmology Clinic; C Stephen Foster, MD, FACS, FACR, FAAO, Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary; Founder and President, Ocular Immunology and Uveitis Foundation, Massachusetts Eye Research and Surgery Institution
Contributor Information and Disclosures

Updated: Dec 27, 2007

Follow-up

Further Outpatient Care

  • Radiotherapy as needed

Complications

  • Metastasis: The most frequent site of metastasis is the lung, followed by the liver, brain, and bone. In managing these patients, it is important to palpate the regional lymph nodes because spread to the ipsilateral preauricular, submandibular, and cervical nodes from the conjunctival sac is well recognized. Cohen et al reported an isolated gastric metastasis from a conjunctival melanoma.4 Gastric metastases are frequently seen in cutaneous melanoma.
  • Intumescent lens: Applied topically, mitomycin-C has reportedly resulted in an intumescent lens, requiring surgical intervention.

Prognosis

  • In several studies, the 5-year survival rate after surgery and/or radiotherapy was 83-84%, and the 10-year survival rate was 69-80%. The 5-year recurrence rate in both studies was 39%.
  • Paridaens et al listed the following prognostic factors associated with a higher mortality (in increasing order of mortality risk)5 :
    • Two-fold risk - Tumors in unfavorable locations (eg, palpebral conjunctiva, fornices, plica, caruncle, lid margins)
    • Three-fold risk - Mixed cell types compared with pure spindle cell types
    • Four-fold risk - Histologic evidence of lymphatic invasion; initial thickness greater than 4 mm for tumors in unfavorable locations only
    • Five-fold risk - Multifocal tumors in patients with lesions in favorable (epibulbar) locations only

Miscellaneous

Medicolegal Pitfalls

  • In an adult, all elevated or enlarged pigmented lesions with a history of change should be excised as suspected malignant melanoma. Any nevus that has increased in vascularity, size, or solidity or that has become fixed to the underlying sclera (nevi always are freely movable over the sclera, except at the fixation point at the limbus) should be suspected of being a malignant melanoma.
  • Note that metastatic melanomas from anywhere in the body and extensions from ciliary body melanomas may first become apparent in the conjunctiva.

Special Concerns

  • Not all conjunctival melanomas are pigmented; melanomas with little or no pigment can look like squamous and sebaceous gland carcinomas, papillomas, lymphoid hyperplasia, and even pterygia. Amelanotic melanomas can even puzzle the pathologist; staining with the S-100 protein stain and the more specific homatropine methylbromide (HMB-45) antibody stain can assist in diagnosis. Since acquired melanosis, nevi, melanomas, and other pigmented lesions (eg, papillomas, adrenochrome deposits, foreign bodies, blood-filled cysts) may have comparable clinical features, biopsies of such lesions usually should be taken before more extensive therapy is considered. A biopsy of a malignant melanoma does not seem to augment its lethality, and it may prevent needless, mutilating surgery.
 
Acknowledgments

The author was a fellow and affiliated with the Ocular Immunology and Uveitis Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, HarvardMedicalSchool, while performing this work.



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References
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References

  1. Jakobiec FA, Brownstein S, Albert W, Schwarz F, Anderson R. The role of cryotherapy in the management of conjunctival melanoma. Ophthalmology. May 1982;89(5):502-15. [Medline].

  2. Strempel I, Kroll P. Conjunctival malignant melanoma in children. Ophthalmologica. 1999;213(2):129-32. [Medline].

  3. Finger PT, Czechonska G, Liarikos S. Topical mitomycin C chemotherapy for conjunctival melanoma and PAM with atypia. Br J Ophthalmol. May 1998;82(5):476-9. [Medline].

  4. Cohen VM, Ahmadi-lari S, Hungerford JL. Gastric metastases from conjunctival melanoma. Melanoma Res. Aug 2007;17(4):255-6. [Medline].

  5. Paridaens AD, McCartney AC, Minassian DC, Hungerford JL. Orbital exenteration in 95 cases of primary conjunctival malignant melanoma. Br J Ophthalmol. Jul 1994;78(7):520-8. [Medline].

  6. Akor C, Greenberg MF, Pollard ZF, Grossniklaus HE. Conjunctival melanoma in a child. J Pediatr Ophthalmol Strabismus. Jan-Feb 2004;41(1):56-8. [Medline].

  7. Amato M, Esmaeli B, Ahmadi MA, Tehrani MH, Gershenwald J, Ross M, et al. Feasibility of preoperative lymphoscintigraphy for identification of sentinel lymph nodes in patients with conjunctival and periocular skin malignancies. Ophthal Plast Reconstr Surg. Mar 2003;19(2):102-6. [Medline].

  8. American Joint Committee on Cancer. AJCC Cancer Staging Handbook from the AJCC Cancer Staging Manual. 5th ed. 1998.

  9. Anastassiou G, Esser M, Bader E, Steuhl KP, Bornfeld N. Expression of cell adhesion molecules and tumour infiltrating leucocytes in conjunctival melanoma. Melanoma Res. Oct 2004;14(5):381-5. [Medline].

  10. Anastassiou G, Heiligenhaus A, Bechrakis N, Bader E, Bornfeld N, Steuhl KP. Prognostic value of clinical and histopathological parameters in conjunctival melanomas: a retrospective study. Br J Ophthalmol. Feb 2002;86(2):163-7. [Medline].

  11. Bajaj MS, Pushker N, Kashyap S, Balasubramanya R, Chandra M, Ghose S. Conjunctival malignant melanoma. Orbit. Mar 2003;22(1):47-53. [Medline].

  12. Baroody M, Holds JB, Kokoska MS, Boyd J. Conjunctival melanoma metastasis diagnosed by sentinel lymph node biopsy. Am J Ophthalmol. Jun 2004;137(6):1147-9. [Medline].

  13. Blumenthal EZ, Garzozi H, Bahir J, Pe'er J. Multiple conjunctival metastases as the initial sign of metastatic uveal melanoma. Am J Ophthalmol. Oct 1997;124(4):549-50. [Medline].

  14. Brownstein S. Malignant melanoma of the conjunctiva. Cancer Control. Sep-Oct 2004;11(5):310-6. [Medline].

  15. Buchwald HJ, Muller A, Spraul CW, Lang GK. [Ultrasound biomicroscopy of conjunctival lesions]. Klin Monatsbl Augenheilkd. Jan-Feb 2003;220(1-2):29-34. [Medline].

  16. Buchwald HJ, Müller A, Kampmeier J, Lang GK. [Optical coherence tomography versus ultrasound biomicroscopy of conjunctival and eyelid lesions]. Klin Monatsbl Augenheilkd. Dec 2003;220(12):822-9. [Medline].

  17. Burr JM, Mitry E, Rachet B, Coleman MP. Survival from uveal melanoma in England and Wales 1986 to 2001. Ophthalmic Epidemiol. Jan-Feb 2007;14(1):3-8. [Medline].

  18. Chen Z, Yan J, Yang H, Wu Z, Pang Y, Ai S, et al. Amniotic membrane transplantation for conjunctival tumor. Yan Ke Xue Bao. Sep 2003;19(3):165-7, 145. [Medline].

  19. Cook BE Jr, Bartley GB. Treatment options and future prospects for the management of eyelid malignancies: an evidence-based update. Ophthalmology. Nov 2001;108(11):2088-98; quiz 2099-100, 2121. [Medline].

  20. Demirci H, McCormick SA, Finger PT. Topical mitomycin chemotherapy for conjunctival malignant melanoma and primary acquired melanosis with atypia: clinical experience with histopathologic observations. Arch Ophthalmol. Jul 2000;118(7):885-91. [Medline].

  21. Demirci H, Shields CL, Shields JA, Eagle RC Jr. Malignant melanoma arising from unusual conjunctival blue nevus. Arch Ophthalmol. Nov 2000;118(11):1581-4. [Medline].

  22. DePotter P, Shields CL, Shields JA, et al. Clinical predictive factors for development of recurrence and metastasis in conjunctival melanoma: a review of 68 cases. Br J Ophthalmol. 1993;77:624-630.

  23. El-Shabrawi Y, Radner H, Muellner K, Langmann G, Hoefler G. The role of UV-radiation in the development of conjunctival malignant melanoma. Acta Ophthalmol Scand. Feb 1999;77(1):31-2. [Medline].

  24. Esmaeli B. Disseminated conjunctival melanoma. Ophthalmology. Dec 2004;111(12):2317; author reply 2317-8. [Medline].

  25. Esmaeli B. Sentinel lymph node mapping for patients with cutaneous and conjunctival malignant melanoma. Ophthal Plast Reconstr Surg. May 2000;16(3):170-2. [Medline].

  26. Esmaeli B. Sentinel node biopsy as a tool for accurate staging of eyelid and conjunctival malignancies. Curr Opin Ophthalmol. Oct 2002;13(5):317-23. [Medline].

  27. Esmaeli B, Eicher S, Popp J, Delpassand E, Prieto VG, Gershenwald JE. Sentinel lymph node biopsy for conjunctival melanoma. Ophthal Plast Reconstr Surg. Nov 2001;17(6):436-42. [Medline].

  28. Esmaeli B, Reifler D, Prieto VG, Amir Ahmadi M, Hidaji L, Delpassand E, et al. Conjunctival melanoma with a positive sentinel lymph node. Arch Ophthalmol. Dec 2003;121(12):1779-83. [Medline].

  29. Esmaeli B, Wang X, Youssef A, Gershenwald JE. Patterns of regional and distant metastasis in patients with conjunctival melanoma: experience at a cancer center over four decades. Ophthalmology. Nov 2001;108(11):2101-5. [Medline].

  30. Espana EM, Prabhasawat P, Grueterich M, Solomon A, Tseng SC. Amniotic membrane transplantation for reconstruction after excision of large ocular surface neoplasias. Br J Ophthalmol. Jun 2002;86(6):640-5. [Medline].

  31. Filik L, Oskay T, Ozyilkan O. Conjunctival involvement in a patient with cutaneous malignant melanoma. Onkologie. Feb 2002;25(1):64-5. [Medline].

  32. Folberg R, McLean IW. Primary acquired melanosis and melanoma of the conjunctiva: terminology, classification, and biologic behavior. Hum Pathol. Jul 1986;17(7):652-4. [Medline].

  33. Folberg R, McLean IW, Zimmerman LE. Conjunctival melanosis and melanoma. Ophthalmology. Jun 1984;91(6):673-8. [Medline].

  34. Francis IC, Coroneo MT, Thompson JF. Surgical management of conjunctival melanomas. Arch Ophthalmol. Aug 1999;117(8):1098-9. [Medline].

  35. Furdová A, Oláh Z, Pesko K. [The TNM classification system in malignant conjunctival neoplasms]. Cesk Slov Oftalmol. May 2000;56(3):154-60. [Medline].

  36. Gear H, Williams H, Kemp EG, Roberts F. BRAF mutations in conjunctival melanoma. Invest Ophthalmol Vis Sci. Aug 2004;45(8):2484-8. [Medline].

  37. Gerner N, Nørregaard JC, Jensen OA, Prause JU. Conjunctival naevi in Denmark 1960-1980. A 21-year follow-up study. Acta Ophthalmol Scand. Aug 1996;74(4):334-7. [Medline].

  38. Gonidi M, Athanassiadou P, Drazinos S, Petrakakou E, Kairis M, Zerva C. Primary malignant melanoma of the conjunctiva of the upper eyelid. A case report. Acta Cytol. Nov-Dec 1997;41(6):1790-2. [Medline].

  39. Groh MJ, Holbach LM, Kühnel B, Conway RM, Naumann GO. [Management of conjunctival malignant melanoma associated with primary acquired melanosis (PAM) using 0.02% mitomycin C eyedrops]. Ophthalmologe. Sep 2003;100(9):708-12. [Medline].

  40. Heegaard S, Jensen OA, Prause JU. Immunohistochemical diagnosis of malignant melanoma of the conjunctiva and uvea: comparison of the novel antibody against melan-A with S100 protein and HMB-45. Melanoma Res. Aug 2000;10(4):350-4. [Medline].

  41. Ho VH, Prager TC, Diwan H, Prieto V, Esmaeli B. Ultrasound biomicroscopy for estimation of tumor thickness for conjunctival melanoma. J Clin Ultrasound. Apr 10 2007;[Medline].

  42. Hu DN. Photobiology of ocular melanocytes and melanoma. Photochem Photobiol. May-Jun 2005;81(3):506-9. [Medline].

  43. Hurst EA, Harbour JW, Cornelius LA. Ocular melanoma: a review and the relationship to cutaneous melanoma. Arch Dermatol. Aug 2003;139(8):1067-73. [Medline].

  44. Iwamoto S, Burrows RC, Grossniklaus HE, Orcutt J, Kalina RE, Boehm M, et al. Immunophenotype of conjunctival melanomas: comparisons with uveal and cutaneous melanomas. Arch Ophthalmol. Dec 2002;120(12):1625-9. [Medline].

  45. Kemp EG, Harnett AN, Chatterjee S. Preoperative topical and intraoperative local mitomycin C adjuvant therapy in the management of ocular surface neoplasias. Br J Ophthalmol. Jan 2002;86(1):31-4. [Medline].

  46. Kiratli H, Shields CL, Shields JA, DePotter P. Metastatic tumours to the conjunctiva: report of 10 cases. Br J Ophthalmol. Jan 1996;80(1):5-8. [Medline].

  47. Laquis SJ, Wilson MW, Haik BG, Fleming JC, Baber W. Conjunctival mycosis masquerading as melanoma. Am J Ophthalmol. Jul 2002;134(1):117-8. [Medline].

  48. Layton C, Glasson W. Clinical aspects of conjunctival melanoma. Clin Experiment Ophthalmol. Apr 2002;30(2):72-9. [Medline].

  49. Le K, Tyszko RM. A presentation of a conjunctival malignant melanoma. J Am Optom Assoc. Oct 1999;70(10):653-60. [Medline].

  50. Lee SB, Au Eong KG, Saw SM, Chan TK, Lee HP. Eye cancer incidence in Singapore. Br J Ophthalmol. Jul 2000;84(7):767-70. [Medline].

  51. Liesegang TJ. Pigmented conjunctival and scleral lesions. Mayo Clin Proc. Feb 1994;69(2):151-61. [Medline].

  52. Lommatzsch PK, Werschnik C. [Malignant conjunctival melanoma. Clinical review with recommendations for diagnosis, therapy and follow-up]. Klin Monatsbl Augenheilkd. Oct 2002;219(10):710-21. [Medline].

  53. Lommatzsch PK, Werschnik C, Gutz U. [Intraocular invasion of melanoma of the conjunctiva]. Klin Monatsbl Augenheilkd. Dec 1999;215(6):370-2. [Medline].

  54. Margo CE. Episcleral pseudomelanoma: late complication of scleral tunnel incision. Am J Ophthalmol. Mar 2003;135(3):387-9. [Medline].

  55. Mathur GB, Kothari RS, Mangal HN, Charan H. Malignant melanoma of conjunctiva. Indian J Ophthalmol. Mar 1971;19(1):34-7. [Medline].

  56. Matsumoto A, Inatomi T, Kinoshita S, Aoki A, Asaeda H, Ishida N, et al. [Analysis of the long-term prognosis for conjunctival malignant melanomas in Japan]. Nippon Ganka Gakkai Zasshi. Jun 1999;103(6):449-55. [Medline].

  57. McKelvie P. Ocular surface impression cytology. Adv Anat Pathol. Nov 2003;10(6):328-37. [Medline].

  58. Meyer A, D'Hermies F, Schwartz L, Morel X, Elmaleh C, Renard G. [Malignant melanoma on primary acquired conjunctival melanosis]. J Fr Ophtalmol. Nov 1999;22(9):983-6. [Medline].

  59. Missotten GS, Keijser S, De Keizer RJ, De Wolff-Rouendaal D. Conjunctival melanoma in the Netherlands: a nationwide study. Invest Ophthalmol Vis Sci. Jan 2005;46(1):75-82. [Medline].

  60. Nawa Y, Hara Y, Saishin M. Conjunctival melanoma associated with extensive congenital conjunctival nevus and split nevus of eyelid. Arch Ophthalmol. Feb 1999;117(2):269-71. [Medline].

  61. Nijhawan N, Ross MI, Diba R, Ahmadi MA, Esmaeli B. Experience with sentinel lymph node biopsy for eyelid and conjunctival malignancies at a cancer center. Ophthal Plast Reconstr Surg. Jul 2004;20(4):291-5. [Medline].

  62. Norregaard JC, Gerner N, Jensen OA, Prause JU. Malignant melanoma of the conjunctiva: occurrence and survival following surgery and radiotherapy in a Danish population. Graefes Arch Clin Exp Ophthalmol. Sep 1996;234(9):569-72. [Medline].

  63. Paridaens AD, McCartney AC, Hungerford JL. Multifocal amelanotic conjunctival melanoma and acquired melanosis sine pigmento. Br J Ophthalmol. Mar 1992;76(3):163-5. [Medline].

  64. Paridaens D, Beekhuis H, van Den Bosch W, Remeyer L, Melles G. Amniotic membrane transplantation in the management of conjunctival malignant melanoma and primary acquired melanosis with atypia. Br J Ophthalmol. Jun 2001;85(6):658-61. [Medline].

  65. Pitz S. Expression of intermediate filaments in conjunctival melanocytic lesions. Graefes Arch Clin Exp Ophthalmol. Oct 2002;240(10):846-50. [Medline].

  66. Pushker N, Kashyap S, Balasubramanya R, Bajaj MS, Sen S, Betharia SM, et al. Pattern of orbital exenteration in a tertiary eye care centre in India. Clin Experiment Ophthalmol. Feb 2004;32(1):51-4. [Medline].

  67. Richtig E, Langmann G, Mullner K, Smolle J. Ocular melanoma: epidemiology, clinical presentation and relationship with dysplastic nevi. Ophthalmologica. Mar-Apr 2004;218(2):111-4. [Medline].

  68. Rodriguez-Ares T, Tourino R, De Rojas V, Becerra E, Capeans C. Topical mitomycin C in the treatment of pigmented conjunctival lesions. Cornea. Mar 2003;22(2):114-7. [Medline].

  69. Rodriguez-Reyes AA, Ríos y Valles-Valles D, Corredor-Casas S, Gomez-Leal A. Advanced conjunctival melanoma. Can J Ophthalmol. Jun 2004;39(4):453-60. [Medline].

  70. Rodriguez-Sains RS. Pigmented conjunctival neoplasms. Orbit. Sep 2002;21(3):231-8. [Medline].

  71. Sacu S, Ségur-Eltz N, Horvat R, Lukas JR, Zehetmayer M. Intumescent cataract after topical mitomycin-C for conjunctival malignant melanoma. Am J Ophthalmol. Aug 2003;136(2):375-7. [Medline].

  72. Sakai H, Yanai T, Kawakami S, Masegi T. Malignant melanoma of the palpebral conjunctiva in a captive fallow deer. J Wildl Dis. Oct 2001;37(4):816-9. [Medline].

  73. Seregard S, Oskarsson M, Spângberg B. Differential expression of nm23 H-1 protein in conjunctival melanoma and potential precursor lesions. Exp Eye Res. Dec 1999;69(6):671-6. [Medline].

  74. Sharara NA, Alexander RA, Luthert PJ, Hungerford JL, Cree IA. Differential immunoreactivity of melanocytic lesions of the conjunctiva. Histopathology. Oct 2001;39(4):426-31. [Medline].

  75. Shields CL. Conjunctival melanoma. Br J Ophthalmol. Feb 2002;86(2):127. [Medline].

  76. Shields CL. Conjunctival melanoma: risk factors for recurrence, exenteration, metastasis, and death in 150 consecutive patients. Trans Am Ophthalmol Soc. 2000;98:471-92. [Medline].

  77. Shields CL, Demirci H, Karatza E, Shields JA. Clinical survey of 1643 melanocytic and nonmelanocytic conjunctival tumors. Ophthalmology. Sep 2004;111(9):1747-54. [Medline].

  78. Shields CL, Shields JA. Conjunctival tumors in children. Curr Opin Ophthalmol. Sep 2007;18(5):351-60. [Medline].

  79. Shields CL, Shields JA. Tumors of the conjunctiva and cornea. Surv Ophthalmol. Jan-Feb 2004;49(1):3-24. [Medline].

  80. Shields CL, Shields JA, Armstrong T. Management of conjunctival and corneal melanoma with surgical excision, amniotic membrane allograft, and topical chemotherapy. Am J Ophthalmol. Oct 2001;132(4):576-8. [Medline].

  81. Shields CL, Shields JA, Gunduz K, Cater J, Mercado GV, Gross N, et al. Conjunctival melanoma: risk factors for recurrence, exenteration, metastasis, and death in 150 consecutive patients. Arch Ophthalmol. Nov 2000;118(11):1497-507. [Medline].

  82. Shields JA, Shields CL, De Potter P. Surgical management of conjunctival tumors. The 1994 Lynn B. McMahan Lecture. Arch Ophthalmol. Jun 1997;115(6):808-15. [Medline].

  83. Shields JA, Shields CL, Eagle RC Jr, Raber IM. Conjunctival metastasis as initial sign of disseminated cutaneous melanoma. Ophthalmology. Oct 2004;111(10):1933-4. [Medline].

  84. Shields JA, Shields CL, Eagle RC Jr, Singh AD, Demirci H, Wolf MA. Pigmented conjunctival squamous cell carcinoma simulating a conjunctival melanoma. Am J Ophthalmol. Jul 2001;132(1):104-6. [Medline].

  85. Shields JA, Shields CL, Freire JE, Brady LW, Komarnicky L. Plaque radiotherapy for selected orbital malignancies: preliminary observations: the 2002 Montgomery Lecture, part 2. Ophthal Plast Reconstr Surg. Mar 2003;19(2):91-5. [Medline].

  86. Shields JA, Shields CL, Gundüz K, Cater J. Clinical features predictive of orbital exenteration for conjunctival melanoma. Ophthal Plast Reconstr Surg. May 2000;16(3):173-8. [Medline].

  87. Shields JA, Shields CL, Luminais S, Eagle RC Jr. Differentiation of pigmented conjunctival squamous cell carcinoma from melanoma. Ophthalmic Surg Lasers Imaging. Sep-Oct 2003;34(5):406-8. [Medline].

  88. Silvers D, Jakobiec FA, Freeman T, et al. Melanoma of the conjunctiva: a clinicopathologic study. In: Ocular and Adnexal Tumors. 1978;583-599.

  89. Singh AD, Campos OE, Rhatigan RM, Schulman JA, Misra RP. Conjunctival melanoma in the black population. Surv Ophthalmol. Sep-Oct 1998;43(2):127-33. [Medline].

  90. Song J, Luo C, Xia R, Jiang S. [Expression of CD44 molecule and its significance in uveal and conjunctival melanomas]. Hua Xi Yi Ke Da Xue Xue Bao. Mar 1998;29(1):38-41. [Medline].

  91. Stratas BA. Conjunctival melanoma: is it increasing in the United States?. Am J Ophthalmol. Dec 2003;136(6):1190; author reply 1190-1. [Medline].

  92. Tosi GM, Rubegni P, Schuerfeld K, Toti P, Cevenini G, Dell'Eva G, et al. Digital surface microscopy analysis of conjunctival pigmented lesions: a preliminary study. Melanoma Res. Oct 2004;14(5):375-80. [Medline].

  93. Tseng SH, Chen YT, Huang FC, Jin YT. Seborrheic keratosis of conjunctiva simulating a malignant melanoma: an immunocytochemical study with impression cytology. Ophthalmology. Aug 1999;106(8):1516-20. [Medline].

  94. Tuomaala S, Aine E, Saari KM, Kivela T. Corneally displaced malignant conjunctival melanomas. Ophthalmology. May 2002;109(5):914-9. [Medline].

  95. Tuomaala S, Eskelin S, Tarkkanen A, Kivelä T. Population-based assessment of clinical characteristics predicting outcome of conjunctival melanoma in whites. Invest Ophthalmol Vis Sci. Nov 2002;43(11):3399-408. [Medline].

  96. Tuomaala S, Kivela T. Metastatic pattern and survival in disseminated conjunctival melanoma: implications for sentinel lymph node biopsy. Ophthalmology. Apr 2004;111(4):816-21. [Medline].

  97. Tuomaala S, Kivelä T. Conjunctival melanoma: is it increasing in the United States?. Am J Ophthalmol. Dec 2003;136(6):1189-90; author reply 1190. [Medline].

  98. Vajdic CM, Kricker A, Giblin M, McKenzie J, Aitken J, Giles GG, et al. Eye color and cutaneous nevi predict risk of ocular melanoma in Australia. Int J Cancer. Jun 15 2001;92(6):906-12. [Medline].

  99. Vajdic CM, Kricker A, Giblin M, McKenzie J, Aitken J, Giles GG, et al. Sun exposure predicts risk of ocular melanoma in Australia. Int J Cancer. Sep 10 2002;101(2):175-82. [Medline].

  100. Vajdic CM, Kricker A, Giblin M, McKenzie J, Aitken JF, Giles GG, et al. Artificial ultraviolet radiation and ocular melanoma in Australia. Int J Cancer. Dec 10 2004;112(5):896-900. [Medline].

  101. Vaziri M, Buffam FV, Martinka M, Oryschak A, Dhaliwal H, White VA. Clinicopathologic features and behavior of cutaneous eyelid melanoma. Ophthalmology. May 2002;109(5):901-8. [Medline].

  102. Wenkel H, Rummelt V, Naumann GO. Malignant melanoma of the conjunctiva with intraocular extension. Arch Ophthalmol. Apr 2000;118(4):557-60. [Medline].

  103. Werschnik C, Lommatzsch PK. Long-term follow-up of patients with conjunctival melanoma. Am J Clin Oncol. Jun 2002;25(3):248-55. [Medline].

  104. Wilson MW, Schelonka LP, Siegel D, Meininger A, Ross D. Immunohistochemical localization of NAD(P)H:quinone oxidoreductase in conjunctival melanomas and primary acquired melanosis. Curr Eye Res. May 2001;22(5):348-52. [Medline].

  105. Yu GP, Hu DN, McCormick S, Finger PT. Conjunctival melanoma: is it increasing in the United States?. Am J Ophthalmol. Jun 2003;135(6):800-6. [Medline].

  106. Zografos L, Uffer S, Chamot L. Unilateral conjunctival-corneal argyrosis simulating conjunctival melanoma. Arch Ophthalmol. Oct 2003;121(10):1483-7. [Medline].

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Further Reading

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Keywords

conjunctival melanoma, malignant melanoma of the conjunctiva, malignancy, tumor, exenteration, cryotherapy

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Contributor Information and Disclosures

Author

Manolette R Roque, MD, MBA, DPBO, FPAO, President and CEO, Chief of Service, Ocular Immunology and Uveitis, Consulting Staff, Cornea and Refractive Surgery, Eye Republic Ophthalmology Clinic; General Manager, Ophthalmic Consultants Philippines Co; Consulting Staff, CME Liaison, Section Chief of Ocular Immunology and Uveitis, Department of Ophthalmology, Asian Hospital and Medical Center
Manolette R Roque, MD, MBA, DPBO, FPAO is a member of the following medical societies: American Academy of Ophthalmic Executives, American Society of Cataract and Refractive Surgery, American Society of Ophthalmic Administrators, American Uveitis Society, International Ocular Inflammation Society, Philippine Medical Association, Philippine Ocular Inflammation Society, and Philippine Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Barbara L Roque, MD, Full Partner, Ophthalmic Consultants Philippines Co, Chief of Service, Pediatric Ophthalmology and Strabismus, Consulting Staff, Orbit and Eye Plastics, EYE REPUBLIC Ophthalmology Clinic
Disclosure: Nothing to disclose.

C Stephen Foster, MD, FACS, FACR, FAAO, Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary; Founder and President, Ocular Immunology and Uveitis Foundation, Massachusetts Eye Research and Surgery Institution
C Stephen Foster, MD, FACS, FACR, FAAO is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Association of Immunologists, American College of Rheumatology, American College of Surgeons, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, American Uveitis Society, Association for Research in Vision and Ophthalmology, Massachusetts Medical Society, Royal Society of Medicine, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Brian A Phillpotts, MD, Former Vitreo-Retinal Service Director, Former Program Director, Clinical Assistant Professor, Department of Ophthalmology, Howard University College of Medicine
Brian A Phillpotts, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Medical Association, and National Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Hospital
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Eye Bank Association of America, Pennsylvania Medical Society, and Philadelphia County Medical Society
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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