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Background: To describe the outcome of patients treated by conservative surgical excision followed by adjuvant plaque brachytherapy for early-stage primary or recurrent conjunctival melanoma. Design: Retrospective, non-comparative, interventional case series. Participants: We reviewed 19 eyes in 19 consecutive patients presenting with biopsy proven conjunctival melanoma with pathologic stage pT1c or less. Methods: Patients with primary or recurrent early-stage conjunctival melanoma were identified and treated using a conservative resection technique (tractional micro-dissection) involving avoidance of deep dissection and modest lateral clearance followed by adjuvant plaque brachytherapy. Main Outcome Measure: Local recurrence and ocular complications. Results: Mean age was 55.2 years and male : female (8:11). Mean follow up was 43.1 months (range 30.1–54.3 months). All patients were treated by conservative resection followed by adjuvant Iodine-125 plaque brachytherapy. The treatment dose was 100 Gy to a depth of 1.5–3.0 mm. Outcomes: median visual acuity and intraocular pressure were unchanged after surgery. Six patients experienced corneal ulceration in the immediate postoperative period. No patients experienced recurrence at the treatment site or metastases. Three patients experienced new lesions distant from the treatment site. Conclusions: Conservative resection and adjuvant plaque brachytherapy is an effective and well-tolerated modality for the management of patients with early-stage conjunctival melanoma.

Purpose: To describe the outcome of patients treated by surgical excision followed by plaque brachytherapy for primary or recurrent ocular surface malignancies with evidence of deep margin (corneoscleral) invasion. Methods: Retrospective, non-comparative, interventional case series. Eleven consecutive patients presenting with biopsy-proven scleral and/or corneal stromal involvement from either conjunctival melanoma (CM) or squamous cell carcinoma (SCC) of the conjunctiva were reviewed. Results: Five patients had CM (pT3 N0 M0 [n = 3], pT4 N0 M0 [n = 2]) and six patients had SCC (T3 N0 M0 [n = 6]). Mean age was 60.8 years and male : female (3 : 8). Mean follow up was 23.4 months (range 12–36 months). All patients were treated with Iodine-125 plaque following biopsy-proven corneoscleral invasion on histopathology. The treatment dose was 100 Gy to a depth of 1.5–2.5 mm. Outcomes: Median visual acuity and intraocular pressure were unchanged after surgery. Five patients experienced corneal ulceration in the immediate postoperative period. None experienced recurrence at the treatment site. One SCC patient and two CM patients experienced new lesions distant from the treatment site. No sight-threatening complications were observed. No patients developed distant metastases. Conclusion: Plaque brachytherapy is an effective and well-tolerated modality for the management of patients with ocular surface malignancy with evidence of localized corneoscleral invasion.

Primary cutaneous lymphoma represents a distinct clinical entity within the spectrum of haematological malignancy. A case of primary cutaneous B cell lymphoma is reported, presenting in an 87-year-old female with a 2-year history of intermittent swelling and discolouration of the right upper and lower eyelids, in the absence of systemic symptoms. Histopathological examination of an incision biopsy revealed a lymphoid infiltrate in the dermis with immunophenotypic features of B cell lymphoma. Staging investigations confirmed the absence of systemic disease. Treatment with oral chemotherapy was undertaken with a good response. Ophthalmologists should include primary cutaneous lymphoma in the differential diagnosis of recurrent eyelid swelling.