Conjunctival Melanoma: A New Clinical and Therapeutical Approach

Abstract

Melanoma involving the conjunctiva is extremely rare. Graver prognosis has been reported with primary conjunctival melanoma than with their cutaneous counterparts [Collin et al.: Aust N Z J Ophthalmol 1986;14:29-34]. Among conjunctival melanomas, two significant risk factors for tumour-related death have been identified: (i) age older than 55 years and (ii) unfavourable tumour location (caruncle, cornea, fornix, palpebral conjunctiva) [Werschnik and Lommatzsch: Am J Clin Oncol 2002;25:248-255]. Here we present a rare case of lentigo maligna involving the palpebral, bulbar conjunctiva and the caruncle. We describe dermoscopic patterns observed and the use of a novel ocular melanoma therapy with topical imiquimod.

Fig. 1

Several ill-defined, millimetric brown and black macules located in the bulbar, palpebral and tarsal conjunctiva and the caruncle could be observed.

Fig. 2

Light and dark brown globules and dots could be observed in a parallel pattern. Brown blotches and arborizing vessels in the palpebral and bulbar conjunctiva were also found.

Fig. 3

Red and gray colours were present mostly in the tarsal conjunctiva. Vessels with a rope-ladder pattern (scar-like) were found.

Fig. 4

Histopathological examination revealed atypical proliferation of melanocytes in a lentiginous pattern. Melanocytes showed a pagetoid distribution between the keratinocytes in the epithelium.

Fig. 5

Melanocytic marker Melan-A expression was consistent with LM in immunohistochemical studies.

Fig. 6

One-year follow-up showed the patient was disease-free.