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Ilyse Kornblau, Matthew W Wilson; Changing Practice Patterns in Conjunctival Malignant Melanoma. Invest. Ophthalmol. Vis. Sci. 2020;61(7):4668.
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© ARVO (1962-2015); The Authors (2016-present)
To review changing practice patterns in the management of conjunctival malignant melanoma over two decades.
A retrospective chart review was conducted to identify patients with conjunctival malignant melanoma treated at a tertiary care center from April 2010 to October 2019 who had at least 1 follow up visit after diagnosis. Data was collected on patient demographics, personal and family history of cancer, time to referral, baseline examination characteristics, treatment, recurrences, metastasis, and death. For patients who underwent tumor excision or exenteration, pathology reports were reviewed for tumor depth, positive margins, ulceration, and lymphovascular involvement. Data was compared to a prior cohort study at the same tertiary care institution from January 1999 to March 2010 to compare changes in practice patterns.
Twenty-one patients with conjunctival melanoma from 2010-2019 (hereafter “recent”) were compared to 21 patients from 1999-2010 (hereafter “prior”). Both cohorts were predominantly white and of similar age. Right and left eyes were similarly affected in both cohorts. Recent patients were more likely to be male (13/21, 61.9% vs. 8/21, 38.1%). In the recent cohort, 12/21 patient underwent biopsy prior to referral compared to 20/21 prior patients. Primary treatment at our center consisted of wide local excision with cryotherapy in 15/21 patients in the recent cohort vs. 20/21 patients in the prior cohort. One patient in each cohort underwent primary exenteration. Primary plaque brachytherapy was performed in one patient in each cohort. Unlike the prior cohort, mitomycin C (MMC) was rarely prescribed, with only one patient receiving it as primary adjunct therapy (recent 3/17, 17.6% vs. prior 15/21, 71.4%). Recent patients had a similar rate of recurrence (7/21, 33.3% vs. prior 5/21, 23.8%), with a slightly higher median number of recurrences (2 vs. 1). Metastasis and death were uncommon in both cohorts (recent 2/21 metastasis, 9.5% and 3/17 deaths, 17.6% vs. prior 3/21 metastasis, 14.3% and 1/21 deaths, 4.8%). Mean follow up time was similar for both cohorts (recent 26.7 months vs. prior 23.6 months).
Compared to the prior cohort, patients seen at a single site tertiary care ocular oncology practice from 2010-2019 with conjunctival melanoma were less likely to have had prior biopsy and receive MMC as adjunct treatment. Both cohorts had a low rate of recurrence, metastasis, and death.
This is a 2020 ARVO Annual Meeting abstract.
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