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Alexander Walters, Katie Keck, Oliver Simmons, Sarah Williams, Steven Cross, Rakesh Patel; Malignant Melanoma Presenting as Amelanotic Caruncular Lesion in a Child. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3355.
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Conjunctival melanoma is a relatively rare malignant neoplasm and an important aspect of the differential diagnosis of childhood caruncular lesions. We report a case of conjunctival melanoma in a young boy who presented with a caruncular mass and discuss the diagnosis and management of conjunctival melanomas in children.
A 10-year-old boy of mixed ethnicity presented to our clinic with a flesh-colored lesion of his left caruncle that had enlarged over the previous 3 months. Comprehensive ophthalmic exam was otherwise normal. The lesion was excised and reported to be BRAF-negative invasive melanoma arising in association with a melanocytic nevus with positive margins of the biopsy. Imaging revealed no metastasis or abnormality. The melanoma was again excised using no-touch technique and double freeze thaw cryotherapy. The ocular surface was reconstructed with an amniotic membrane graft. Sentinel nodes were negative by lymphoscintigraphy and sentinel node biopsy. Pathology of the lesion revealed residual melanoma in situ with pagetoid spread extending to the margins. The patient was referred to ocular oncology at Wills Eye Hospital for further evaluation and management.
In children, conjunctival melanoma most commonly arises from conjunctival nevi. Caruncular involvement is an especially worrisome feature thought to be associated with greater mortality and morbidity. Current surgical treatment usually consists of en bloc removal, utilizing the “no touch” technique to decrease the risk of seeding. Double freeze-thaw cryotherapy as an adjuvant therapy has been shown to significantly decrease tumor recurrence rates. The lack of BRAF mutation in our patient’s lesion may suggest better prognosis.
No case reports of caruncle melanoma arising from a nevus in a child could be found in a literature search. Conjunctival melanoma should be considered in the differential diagnosis of pediatric patients presenting with caruncular lesions.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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