Abstract
Purpose :
Concurrent melanoma involvement of the eyelid and conjunctiva is rare with lack of consensus treatment standards. In this study, we identified presenting clinical features and treatment outcomes in patients with concurrent eyelid and conjunctival melanoma who underwent globe sparing treatment or exenteration.
Methods :
Single academic center retrospective review of patients with biopsy-confirmed concurrent eyelid and conjunctival melanoma between January 1, 2000 and December 31, 2021. Records were reviewed for demographics, presenting tumor features, and treatment approaches. Primary endpoints included recurrence, metastasis, and mortality.
Results :
There were 16 patients diagnosed with concurrent eyelid and conjunctival melanoma at mean age 71 years, of whom 9 (56%) were male and all were white. Presumed origin of melanoma was the conjunctiva in 12 patients (75%), eyelid in 3 (19%), and indeterminate in 1 (6%). Mean tumor largest basal diameter was 8.0 mm (range 1.2-17.0), and mean tumor thickness was 1.5 mm (0.5-6.0). Primary treatment was exenteration in 8 patients (50%), wedge resection in 6 (38%), and Mohs micrographic surgery in 2 (12%). One patient treated with primary wedge resection underwent secondary exenteration due to tumor recurrence. For all patients, mean time to date last seen was 82 months (1-450). Local tumor recurrence occurred in 5 patients (31%) after mean time 50 months (18-160), with metastasis in 4 patients (25%) after mean 29 months (16-46). Three of these patients (75%) had metastasis to the parotid gland. Seven patients (44%) died mean of 41 months (7-107) after initial melanoma diagnosis, with 3 deaths attributable to melanoma. In the 7 patients managed with globe sparing treatment, 5 patients (71%) had best-corrected visual acuity ≤20/40 at last follow-up and 2 patients (29%) had visual acuity between 20/50 and 20/200. Among the 3 patients who experienced melanoma-related mortality, all had primary exenteration.
Conclusions :
Melanoma presenting with simultaneous eyelid and conjunctival involvement is rare. Overall, 7 out of 16 eyes were spared in this cohort, with stable visual function after treatment. Globe sparing surgery may be appropriate in carefully selected cases, while advanced, exenteration-requiring melanoma is a serious disease with high risk of melanoma-related death.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.