Outcomes in 15 patients with conjunctival melanoma treated with adjuvant topical mitomycin C: complications and recurrences

Abstract

Purpose: To report the long-term complications and rate of local recurrence in a cohort of patients with histopathologically confirmed conjunctival melanoma (CM) treated with adjuvant topical mitomycin C (MMC).

Design: Retrospective, nonrandomized interventional study.

Participants: Fifteen patients with histopathologically confirmed diagnosis of CM treated with topical MMC.

Methods: We identified all patients with histopathologically confirmed diagnosis of CM treated with topical MMC between January 1999 and March 2010. Data extracted from the patients' medical records included demographic, clinical, and histopathologic findings; treatments; long-term complications (>6 months) of MMC therapy; recurrent and metastatic disease; and mortality.

Main outcome measures: Prevalence of long-term complications of MMC and development of recurrent disease were assessed.

Results: Fifteen patients (12 female) received topical MMC a median of 2.8 months (0.37-110.9 months) after the diagnosis of CM. Median age at diagnosis was 62 years (29-82 years), and median length of follow-up was 23.8 months (2.2-130.8 months). Most common complications included injection (n=13), tearing (n=10), irritation (n=9), pain (n=9), and limbal stem cell deficiency with keratopathy (n=4). Twelve patients (80%) experienced at least 1 long-term complication, with failure of resolution of symptoms in 7 of these patients. Local recurrence was associated with longer delay to MMC initiation (2 ±8.0 vs. 30.8 ±11 months, P=0.06). Three patients developed metastases. Recurrence was associated with metastatic disease (P=0.001). Exenteration was required in 2 patients, 1 of whom developed metastatic disease and died.

Conclusions: Careful consideration should be given to the use of adjuvant MMC for the treatment of residual intraepithelial disease after the diagnosis of CM given the risk of potential long-term ocular surface toxicities.