Abstract
Abstract: :
Purpose:To treat diffuse multifocal primary acquired melanosis with atypia and conjunctival melanoma with topical mitomycin chemotherapy. Methods:Mitomycin was used as a primary treatment for residual epithelial disease in 10 patients and as an adjuvant to excision and cryotherapy in 6. Primary treatments consisted of Mitomycin 0.04% Q.I.D. for 28 days (two 14 day cycles) and for 7 consecutive days as adjuvant therapy. After topical chemotherapy, patients were followed for both local recurrence and metastatic disease. Results: Sixteen patients were followed for a mean 72.5 months (range 6 to 126 months) after treatment. Two patients discontinued the drops after 14 days due to the development of severe keratoconjunctivitis (n=1) or an allergic reaction (n=1) to the drops. Regression of the tumor was seen in all 16 patients but recurrence was noted in 8 (3 adjuvant and 5 of the primary treatment patients). Three underwent orbital exenteration and the remaining 5 were treated conservatively. The mean time of recurrence was 36.9 months. The short–term complications of mitomycin treatment were transient keratoconjunctivitis (n=14), severe keratoconjunctivitis (n=1) and 1 corneal abrasion that led to the formation of a scar. The long–term complications included pannus (n=2) and corneal haze (n=1). Symblepharon was noted in one patient. Visual acuity was within 2 lines of their pretreatment in 14 patients (including measurements just prior to exenteration). The patient with pannus lost 7 and the corneal scar 5 ETDRS lines of vision. Three patients died, 1 of metastatic melanoma. Conclusions: Conjunctival melanoma and primary acquired melanosis responded to mitomycin 0.04% topical chemotherapy, subepithelial rests appeared resistant to treatment, and treatment related complications were acceptable. With long–term follow up, this regimen yielded an overall recurrence rate of 50%.
Keywords: tumors • conjunctiva • melanoma