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Background: Neoplasms of the conjunctiva include many different entities with a broad variety of clinical presentations. This can make a precise clinical diagnosis difficult. R0 resection is the gold standard treatment for most malignant conjunctival neoplasms, but not every benign lesions must treated by excision. In clinical practice it is important to make an accurate clinical diagnosis to enable the best possible management of conjunctival neoplasms., Objective: The aim of this study was to determine the accuracy of clinical diagnosis of neoplasms of the conjunctiva., Materials and Methods: Within a retrospective design, the data from all patients with excision of a conjunctival lesion between 2011 and 2020 in the Department of Ophthalmology of the UKSH Campus Kiel were extracted and analyzed. The specificity, sensitivity, and positive and negative predictive value for the preoperative clinical rating of dignity and diagnosis were evaluated based on the histological diagnostic findings., Results: Of 220 included cases, 75% were benign and 25% malignant. The most frequent neoplasm of the conjunctiva was benign conjunctival nevus. The sensitivity for clinical prediction of a benign lesion was 0.86 (95% confidence interval [CI] 0.59-0.92), the specificity 0.95 (CI 0.85-0.99), and the positive predictive value 0.98 (CI 0.94-1.0). The sensitivity for clinical prediction of malign dignity was 0.95 (CI 0.85-0.99), the specificity 0.88 (CI 0.83-0.93), and the positive predictive value 0.73 (CI 0.61-0.83)., Conclusion: The derived values for clinical diagnosis of conjunctival neoplasms can be rated as good. However, in clinical practice, untypical lesions can be hard to diagnose correctly, and the clinical diagnosis should be carefully reviewed; if in doubt, excision should be preferred., (© 2024. The Author(s).)

A lymphoepithelial carcinoma of the conjunctiva was excised in an 80-year-old female patient. The otorhinolaryngeal (ENT) examination did not show any abnormalities and nasopharyngeal or systemic metastases were absent. A strictly controlled clinical follow-up of the excision site was scheduled. A lymphoepithelial carcinoma of the eye is very rare and it is classified under the nasopharyngeal carcinomas. The diagnostics and therapy are an interdisciplinary task involving ENT, radiology, pathology and oncology and if the tumor cannot be completely excised, radiotherapy is also included.

A 26-year-old female patient was referred because of a persisting swelling and redness of the conjunctiva for 4 months accompanied by pruritus. An ultrasound biomicroscopy showed hypoechogenic structures separated by multiple hyperechogenic septa. A biopsy was performed which revealed a marginal B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) type. A generalized lymphatic disease could be excluded by positron emission tomography-computed tomography (PET-CT). In agreement with the patient an extensive excision was performed followed by a wait and see strategy including close monitoring by ophthalmological and general internist control examinations.

We report the case of a 71-year-old male who was first diagnosed with conjunctival squamous cell carcinoma in September 2010. The lesion was excised twice and cryotherapy of the margins was performed. On histology the margins were not tumor-free but this was not followed up by further excision. After 5 months the patient was referred to this department with a growing tumor mass which had infiltrated into the anterior chamber and partly destroyed the iris. Because of this advanced finding extended enucleation was performed. The histological examination showed a well differentiated squamous cell carcinoma and no evidence of metastasis in lymph nodes or elsewhere could be found by conventional computed tomography (CT) and positron emission CT (PET-CT).

The case of a 73-year-old woman with a perforated corneal ulcer in the remaining eye with migrating endophthalmitis is presented. In addition, the affected eye had non-abradable whitish coating (leukoplakia) on the tarsal conjunctiva. The cause of leukoplakia was initially histologically diagnosed after an incisional biopsy as focal invasive sebaceous carcinoma with pagetoid growth. After exenteration of the orbit it was confirmed to be an early invasive, non-keratinizing squamous cell carcinoma (G2) of the conjunctiva, which had emerged from a spinocellular carcinoma in situ. The early histological differentiation of malignant lesions in the conjunctiva can be extremely difficult because the pathological changes in the tissue are very similar due to the cell metaplasia.

In this article we discuss the complex diagnostic approaches and therapeutic options for the most important conjunctival malignancies. Conjunctival melanoma can be a diagnostic challenge as it can be difficult to distinguish from benign melanocytic conjunctival tumours. Complete surgical excision accompanied by a coherent adjuvant concept is the key for a curative therapy. Moderate and severe conjunctival intraepithelial neoplasias (CIN) are precancerous lesions and can progress to invasive squamous cell carcinoma. The involvement of large parts of the ocular surface can prevent an R 0-resection. Adjuvant therapeutic concepts are therefore especially important to gain tumour control and preserve the function of the affected eye. Lymphomas are the most common malignant primary tumours of the orbit and ocular adnexa. They can present as primary or secondary tumours of the conjunctiva, the lacrimal gland, the orbital fat, the eye lid or the lacrimal sac. The most common manifestation site of ocular MALT lymphoma is the conjunctiva with 20 - 33 % of all epibulbar lymphomas. More than 75 % of ocular lymphoma patients develop only one lymphomatous lesion. Immunophenotyping allows the exact differentiation between the lymphoma entities. Infectious agents (e.g., Chlamydia psittaci) seem to play a role in the pathogenesis. An overview over radiotherapeutic approaches that are conclusively applicable at the conjunctiva completes the article., (© Georg Thieme Verlag KG Stuttgart · New York.)

Patient 1 developed snowflake-like keratitis without inflammatory response in a decompensated corneal allograft. Patient 2, who had a history of repeated corneal grafting, also developed corneal opacification which initially appeared thread-like but quickly expanded. In both patients regrafting was necessary. Histological examination of the excised corneas demonstrated dense populations of Gram-positive bacteria in the interlamellar spaces. A surrounding inflammatory reaction was lacking, which is typical for infectious crystalline keratopathy (ICK).

Conjunctival myxoma is a rare and benign tumour without tendency for recurrence. Here, we present the histological features and the clinical course of two cases. Removal of each tumour was followed by histopathological examination including immunohistochemistry as well as electron microscopy. Besides the expected findings characteristic of conjunctival myxoma some features reflecting the possible aetiology of this entity are shown.

The conjunctiva as a mucous membrane provides a protective barrier to the eye. It represents a small segment of the skin - the largest organ of the body, which has a size of about 1.7 square metres. For this reason conjunctival ageing is affected by equivalent processes as skin ageing. Common causes for these ageing processes are biological and genetic effects as well as environmental conditions and exposure to light. The resulting dysfunction in conjunctival homoeostasis and protective function represent common factors which contribute to increased incidences of tumours and malignant transformations in elderly patients. At the time of tumour manifestation the patient's age is an important parameter for differential diagnosis and regimen strategy. All therapeutic options (surgical incision or excision, cryotherapy, chemo- or radiotherapy, exenteratio orbitae etc.) have to be determined individually depending on clinically relevant findings and previous anamnesis. Due to the patient's age geriatric aspects have to be considered in therapeutic management (tissue fragility, wound healing, multimorbidity, decreased adherence)., ((c) Georg Thieme Verlag KG Stuttgart New York.)

Recent data suggest neurodermatitis as a risk factor for ocular surface squamous neoplasia (OSSN). We describe two cases of bilateral OSSN associated with chronic atopic keratoconjunctivitis. The cases support the hypothesis that neurodermatitis is a risk factor for OSSN. Additional risk factors may facilitate development and progression of the disease.

Background: Because of the high local recurrence rates after excision of conjunctival melanomas, adjuvant local chemotherapy or irradiation is recommended. Strontium-90 brachytherapy is one radiotherapeutic option due to its low penetration depth., Methods: 15 patients with conjunctival melanoma were treated with adjuvant strontium-90 brachytherapy after tumour excision. The treatment was fractionated into 9 irradiation sessions with 6 Gy each. The mean follow-up was 35 months (12-60 months)., Results: Seven patients (46%) had no recurrence during the follow-up. Three patients (20%) had a recurrence in the treated or adjacent area. Eight patients (53%) developed new tumours in non-treated areas., Conclusions: Strontium-90 brachytherapy is a useful adjuvant in the treatment of conjunctival melanomas. Regular ophthalmoscopic controls are necessary because of the high rate of new tumours in non-irradiated areas, especially in cases with primary acquired melanosis.

Purpose: The aim of this study is to illustrate our personal experience concerning the diagnostic and therapeutic management of primary and secondary orbital melanomas., Patients and Methods: Nine patients (five men and four women) with a histological diagnosis of orbital malignant melanoma were surgically treated in our department during the last 10 years (1995 - 2005)., Results: All the patients had a unilateral orbital malignant melanoma. A primary tumour was diagnosed in one case. There was metastatic orbital localisation of a cutaneous malignant melanoma in two cases. In six cases, a secondary melanoma originated from the uveal tract (three cases), conjunctiva (two cases), or paranasal sinuses (one case). All the patients underwent surgical treatment of the tumour (exenteration in 5 cases; subtotal exenteration in one case; subtotal excision in two cases; and craniofacial resection in one case) combined with immunotherapy in one case. The median age at surgery was 66 years, with a mean postoperative follow-up of 17 +/- 14 months. Four patients died of widespread dissemination of the melanoma after a mean time of 13 +/- 7 months. Two more patients died of causes other than melanoma. Three patients were still living at 9, 33 and 45 months after surgery. None of the patients presented with a local relapse of the melanoma during follow-up., Conclusion: Although different approaches have been proposed, the prognosis of orbital melanoma remains poor. In our experience too, the patients with longest survival were those whose tumours were exenterated.

Background: Here we present a case of a female patient with squamous cell carcinoma with orbital invasion who insisted on a globe-sparing excisional biopsy rather than a more invasive procedure., Case: A 48-year-old patient presented with a conjunctival tumor at the medial canthus of the right eye. The visual acuity in this eye was 1.0. MRI showed a 25 mm x 12 mm tumor, with orbital invasion, no metastasis, but on CT scan damage of the lamina papyracea was suspected. Histology of a punch biopsy confirmed a moderately differentiated, squamous cell carcinoma. As requested by the patient, simple tumor excision with a 5-mm safety margin, reconstruction of the lower fornix with amniotic membrane, and adjuvant mitomycin C therapy were performed. Intraoperatively the medial orbital wall was found to be intact. No local or systemic recurrence has occurred 3.5 years postoperatively. The patient's VA is still 1.0; no visual field defects are detectable, and there are only minor upper lid levator restriction and diplopia in maximum upgaze., Conclusion: In view of this case the choice of surgical treatment for malignant tumors of the conjunctiva with orbital invasion - between exenteration or a minimally invasive procedure - should be carefully discussed with the patient. A follow-up of 5 years is strongly recommended.

Purpose: The aim of this study was to evaluate the role of topical interferon-alpha-2b in the adjuvant treatment of corneal and conjunctival tumors., Method: In this noncomparative, prospective, interventional case series, five patients with histologically proven conjunctival intraepithelial neoplasia (CIN) after primary excision and amniotic membrane transplantation were treated with interferon (IFN)-alpha-2b eye drops five times daily over a period of 6 weeks (1 million IU/ml Intron A, Schering). An in situ hybridization technique was used to detect human papillomavirus (HPV) in all specimens. Frequent follow-up was undertaken clinically and photographically for evidence of tumor recurrence., Results: In the follow-up period (13.2+/-4,97 months) no clinical evidence of recurrence with only limited treatment side effects such as mild conjunctival hyperemia were recorded after 6 weeks of interferon. In one CIN specimen HPV 16/18 could be detected., Conclusions: The combination of excisional biopsy and topical interferon-alpha-2b application seems to be an effective and safe treatment for conjunctival intraepithelial neoplasias. Therefore, we prefer this combined treatment to topical interferon-alpha-2b treatment alone, more destructive approaches such as radiation and cryotherapy, or treatment with antimetabolites such as 5-fluorouracil or mitomycin C.

The ocular adnexal lymphomas represent the malignant end of the spectrum of lymphoproliferative lesions which occur in the conjunctiva, eyelids, lacrimal gland and orbit. The new "W.H.O. Classification of Tumours of Haemopoietic and Lymphoid Tissues" is the most suitable for subdividing the ocular adnexal lymphomas, whereby the extranodal marginal zone B-cell lymphoma (EMZL) represents the most common lymphoma subtype. Management of patients with ocular adnexal lymphomas includes a systemic medical examination to establish the clinical stage of the disease. Most patients have stage IE disease and current recommended therapy for this is radiotherapy, while disseminated disease is treated with chemotherapy. Despite usually demonstrating an indolent course, EMZLs are renowned for recurrence in extranodal sites, including other ocular adnexal sites. Furthermore, Blastic transformation of EMZL with a corresponding aggressive clinical course has been described. Long-term follow-up with half-yearly examinations are therefore recommended. Major prognostic criteria for the ocular adnexal lymphomas include the age of the patient, anatomical location of the tumour, stage of the disease at first presentation, serum lactate dehydrogenase level at the time of diagnosis, lymphoma subtype as determined using W.H.O. lymphoma classification and the tumour cell growth rate. The clinical symptoms and histopathological findings of the differential diagnosis of lymphoproliferative lesions of the ocular adnexa are discussed.

Background: Squamous cell carcinoma of the conjunctiva is rare. Together with epithelial dysplasia of the conjunctiva the incidence is reported to be 1.9 per 100,000 population and year. After adequate therapy total cure is often achieved. Generalised metastases are however extremely rare., Patient and Method: The case of a 71-year old white male patient is presented. Because of a recurrent conjunctival tumour in his right eye local resections had to be performed. The histopathological diagnosis was epithelial dysplasia. After a 3-year history a squamous cell carcinoma developed. In spite of multiple operations total excision of the tumour could not be achieved. Exenteration was refused by the patient. After radiotherapy of the orbit a temporary improvement was observed. However, 9 years later the patient died of general metastases to the long bones, the spine, and the ribs., Results: Histological examination of material obtained during hemilaminectomy of the vertebrate bodies 8 and 9 confirmed the diagnosis of metastases of a squamous cell carcinoma., Conclusion: Although extremely rare, general metastases after squamous cell carcinoma of the conjunctiva must be kept in mind. This has to be considered when obtaining informed consent of the patient, planning adequate therapy and follow-up.

Background: Squamous cell carcinoma of the conjunctiva is a mostly solitary growing tumor located at the limbus region, which seldom invades the eye. We present an unusual case of conjunctival carcinoma with marked intraocular involvement, which appeared primarily as a chronic inflammation with corneal ulcer., Case Report: A 89-year-old female patient was referred to our institution with a suspected ulcus rodens of the cornea. Since one year a refractory conjunctivitis persisted despite of different local treatment. At first presentation, a marked bacterial keratoconjunctivitis with circular necrosis of the conjunctiva, corneal infiltration and perforation was seen. Visual acuity of the right eye was light perception. The left eye was unremarkable. Enucleation of the right eye was performed. Histopathologic examination revealed the diagnosis of squamous cell carcinoma of the conjunctiva with intraocular involvement. There was a marked infiltration of the choroid even behind the equator. No metastases were found., Conclusion: Advanced squamous cell carcinoma associated with superinfection may present as a primary inflammatory process. There may be extensive involvement of the choroid. Metastases are probably rare even in advanced cases of this type of carcinoma.

Background: Conjunctival intraepithelial neoplasia (CIN) is a frequent conjunctival tumor. Following excision alone recurrences are frequent. An effective postsurgical recurrence prevention is therefore highly desirable. In this study we aimed to evaluate the effectivity of postsurgical chemotherapy of conjunctival squamous cell carcinoma in situ (CIN) with mitomycin C eyedrops. We introduced the otherwise established diagnostic tools of cytology and DNA-image-cytometry to the diagnosis and therapy-monitoring of CIN., Patients and Methods: We treated 9 patients with CIN. For diagnosis the results of cytology and cytometry of presurgically obtained brush smears were compared with the histologic evaluation of the excised tissue. After surgery, we administered topical chemotherapy with mitomycin C eye drops 0.02% (MMC). Conjunctival brush smears were again evaluated by cytology and DNA-image-cytometry for postsurgical therapy monitoring., Results: The clinical diagnosis of CIN was fully confirmed by cytology, DNA-image-cytometry and histology respectively in 7 patients. In one patient, the results of the applied diagnostic methods differed in results: Histologic evaluation indicated a moderate dysplasia but DNA-image-cytometry showed significant DNA-aneuploidy unequivocally indicating neoplasia like squamous cell carcinoma. In another patient the preoperatively obtained conjunctival brush smears could not properly analyzed by cytometry but clinical diagnosis was confirmed by histology. MMC-therapy was well tolerated except for a self-limited conjunctivitis. A complete remission of CIN was obtained in 8 of 9 patients (89%) who were free of CIN recurrences during a follow-up period of 27.2 months (11-48). Only one patient suffered from a recurrence 14 months after surgery and after 2 MMC-cycles., Conclusion: Adjuvant topical mitomycin C appears to be effective in the prevention of recurrences of conjunctival CIN after surgical removal. Our results indicate that at least 4 cycles of topical MMC are required to prevent local recurrences in the long term. Cytology and DNA-image cytometry are highly sensitive and specific methods for diagnosis and therapy monitoring of conjunctival squamous cell carcinoma in situ (CIN).

Background: The treatment of a localised conjunctival melanoma usually requires local excision combined with cryotherapy, brachytherapy and/or local chemotherapy., Case Report: A 71 year old woman suffering from a conjunctival melanoma located at the limbus of her left eye was treated by local excision and cryotherapy. After this therapeutic procedure two recurrences occurred which had been again treated by excision and cryotherapy and finally brachytherapy. Nevertheless, a third recurrent tumor developed and was treated again with deep lamellar sclerectomy and keratectomy. During this procedure the anterior chamber was opened inadvertently in a tiny spot. Some months later an intraocular invasion of the melanoma was diagnosed clinically and the eye had to be enucleated 5 years after the first treatment. Histological examination revealed extended melanoma growth into iris, ciliary body, anterior choroid, and tumor cell seedings in the antertior chamber., Conclusions: Removing a conjunctival melanoma especially such a tumor growing at the limbus, the surgeon has to pay attention not to open the anterior chamber during sclerectomy and keratectomy. The possibility that prior local surgical excision aided the intraocular extension is discussed.

A 23-year-old female presented with a yellow-brownish, asymptomatic tumour of the bulbar conjunctiva in her left eye. The lesion had been detected 5 years previously and had grown since then. Prior to presentation there were 2 episodes of intratumoral hemorrhage. Funduscopy revealed tortuous vessels on the left. Complete tumour excision was performed. Histology showed numerous channels lined by a flat endothelium, and inflammatory cells in the fibrous septae. A diagnosis of a conjunctival lymphangioma was established. The tortuosity of the retinal vessels was probably associated by chance or caused by an undetected orbital lymphangioma.

Unlabelled: Unpigmented tumorous changes of the conjunctiva can frequently be classified as chalazion, basalioma or carcinoma., Patient and Methods: In a 70 years old diabetic female a 2.5 x 2.5 cm tumor of the lower conjunctival fornix was observed. After complete excision the tumor was examined by histologic routine procedures and immunohistochemically. The patient was irradiated by 40 Gy with the linear accelerator., Results: The monotypical secretion of the heavy chain gamma and the light chain kappa demonstrated a well differentiated extramedullar plasmocytoma. A MALT lymphoma could be excluded by the absence of centrocytoid cells. The bone cytology and histology did not give any evidence for a medullar plasmocytoma. The patient is free from local or diffuse tumor growth since 2 1/2 years., Conclusion: Since the worldwide most important ophthalmopathologic statistics of the AFIP from 1984-1989 describes only 1 plasmocytoma out of 2104 tumors of the lids and conjunctiva, the demonstrated case is an important rarity.

A 72-year-old woman presented with a lesion in her right eye, which had developed over 2 years. The cherry red lesion was located in the bulbar conjunctiva in the area of the plica semilunaris. Ophthalmologic examination was otherwise normal. Differential diagnosis included a pyogenic granuloma and a hemangioma. Excision of the tumor was performed. Histological examination revealed solid nests and cords of polyhedral cells exhibiting abundant, finely granular acidophilic cytoplasm and round to oval paracentral nuclei usually containing a single prominent nucleolus. The diagnosis of oncocytoma was established. Ocular oncocytomas are rare neoplasms and are mostly found in the caruncle. A location in the bulbar conjunctiva is extremely rare and only two reports are found in the literature with both of these located in the plica semilunaris.

A clinicopathologic study of a granuloma telangiectaticum is reported in 37 year-old-woman. The tumor has a reddish to white colorit. Its rapid growth, within 2 weeks and appearance as well as clinical examination suggested a neoplastic process (squamous cell carcinoma). The patient had no trauma or surgery. The histopathological examination revealed a granuloma telangiectaticum. Local excision was curative.

Background: Epithelial tumors of the epibulbar conjunctiva are rare in northern Europe. There are no reliable clinical criteria to predict the histological nature of the lesion. Even histologically proven malignant tumors typically do not show ocular invasion or metastasis., Patients and Methods: From 1980 to 1993, 112 epithelial epibulbar tumors were classified in our ophthalmopathological laboratory. Surgical management of 50 papillomas (mean age 46 +/- 18 years, 58% males), 49 conjunctival/corneal intraepithelial neoplasias (CIN) (28 mild, 21 severe) and 12 squamous cell carcinomas (mean age 63 +/- 13 years, 69% males) included excisional biopsy (61%), with additional lamellar keratectomy (14%), epithelial abrasion (10%), cauterisation (3%), cryotherapy (2%), excimer laser ablation (2%). Other management regimes were lamellar keratoplasty (2%), penetrating keratoplasty (2%), epithelial abrasion (2%). One eye with intraocular invasion of a mucoepidermoid carcinoma was enucleated., Results: Fifty five per cent of the papillomas were located at the caruncle or semilunar fold. Seventy eight percent of the papillomas had a pedunculated appearance. Two lesions involved the epibulbar conjunctiva as well as the opposite tarsal conjunctiva ("kissing papilloma"). Eighty eight percent of CIN/carcinoma were located at the limbus. The clinical differential diagnoses of CIN/carcinoma were squamous cell carcinoma (26%), papilloma (18%), leukoplakia (10%), pinguecula/pterygium (10%), dysplasia (8%), malignant melanoma (5%), trachoma (3%), chronic keratoconjunctivitis with corneal pannus (2%), "granuloma" (2%), non-pigmented naevus (2%). After a mean follow-up of 6.3 +/- 3.5 years, 13% of the papillomas showed a local recurrence. After a mean follow-up of 4.8 +/- 3.7 years, there were 30% local recurrences of CIN/carcinoma (50% each in severe CIN and carcinoma, 9% in mild CIN). But there was no recurrence of CIN/carcinoma in patients who had received a complete tumor resection initially. If the surgical margins were involved, there was a 64% recurrence rate (80% each in severe CIN and carcinoma). Thirteen per cent of the patients with CIN/carcinoma showed an additional malignant tumor elsewhere in the body., Conclusions: Local recurrences after excision of CIN/carcinoma did occur only if the surgical margins where involved, and most often within the first year following surgery. Dedifferentiation of epithelial tumors in recurrences was not observed. The diagnosis of CIN/carcinoma of the conjunctiva requires the exclusion of an additional extraocular neoplasia. Histopathological classification and assessment of resection margins of epibulbar tumors is indispensable, especially in view of the more aggressive treatment necessary in mucoepidermoid carcinomas.

Patient: A 55-year-old man was treated twice with local excision and crycoagulation for a recurrent limbal mass of the left eye. The original histologic diagnosis was squamous cell carcinoma. Three months after the last recurrence the globe was enucleated because of a spontaneous perforation at the corneoscleral limbus with iris prolapse. Histologic examination, including PAS and mucicarmine stains, revealed a mucoepidermoid carcinoma of the epibulbar conjunctiva with infiltration of the cornea, sclera, iris and ciliary body., Conclusions: Examination of specially stained sections (e.g. with mucicarmine) should be routinely performed for those conjuctival neoplasms that contain a squamous component. Aggressive surgical management, such as early enucleation including normal appearing tissue next to the globe, should be considered for treatment of primary mucoepidermoid carcinoma to avoid later exenteration or metastasis.

We treated patients with Kaposi's sarcoma of the lid or conjunctiva, molluscum contagiosum and papilloma of the lid with dye laser photocoagulation. This therapeutic device is extremely efficient as the chosen wavelength of 577 nm is absorbed selectively by haemoglobin. Since Kaposi's sarcoma is a haemoglobin-containing tumour composed of endothelial cells and papilloma is a benign tumour composed of connective tissue and branching vessels, dye laser photocoagulation causes selective damage to abnormal vessels and surrounding connective tissue. After local anaesthesia a small incision was made at the margin of the lesion five patients each with papilloma and with molluscum contagiosum. In six patients with Kaposi's sarcoma no incision had to be done. Starting from the incision or the margin of the Kaposi's sarcoma 50-100 shots of 0.3-0.5 mm diameter and 1 s duration were applied until the lesion was completely gone. We used a dye laser with 577 nm wavelength and 1 W energy. In patients with papilloma, the tumour basis was coagulated and the tumour itself underwent histological examination. There was a marked decrease of the size of the lesion or even complete disappearance. Since Kaposi's sarcoma in AIDS patients can be relatively fast growing, resulting in cosmetically irritating manifestations and, rarely, haemorrhages, treatment may become necessary. AIDS patients with molluscum contagiosum may also benefit from treatment, as spreading of DNA virus particles may result in viral follicular conjunctivitis. Dye laser photocoagulation, however, cannot protect against relapse.

We report on the case of a 70-year-old caucasian woman with a large linear sebaceous naevus with multifocal intralesional basaliomas and a lipodermoid of the left eye. This rare finding has been preserved because of the special history of the patient. The naevus spread on the left side from parietal to retroauricular, nuchal and sternal. Because of the patient's cardio-pulmonary insufficiency we excised the basaliomas under local anaesthesia. We also made a partial stripped excision of the left-sided parietal parts of the naevus.

Background: In tumor excision of large malignant melanomas of the conjunctiva or in the excision of widespread precancerous melanosis the development of symblepharon is a threatening complication after conjunctivectomy, especially if the conjunctival fornix is afflicted., Patients: Three patients with suspected nodular melanoma and surrounding precancerous melanosis of the conjunctiva were treated by extended excision of the conjunctiva. Instead of a conjunctival graft, spontaneous epithelization under the protection of an 'Illig' contact lens was achieved. After this, two patients with histologically proven malignant melanomas were treated by beta-ray radiation with 90-Strontium., Results: Within four weeks after the excision a complete epithelization of the wound occurred and the functional as well as the cosmetic results were very satisfying. During the follow-up between 12 and 22 months no recurrence of the melanomas and no formation of symblepharon was observed., Conclusions: With regard to these results extended tumor excision without conjunctival graft seems to be a reasonable therapy for large nodular melanomas and widespread melanosis, while the application of an 'Illig' contact lens avoids the formation of symblepharon.

Tumors of the conjunctiva are rare, especially malignant epithelial tumors. Although these tumors grow very slowly and only exceptionally with local invasion, intensive treatment is necessary. We studied the results of combined treatment with excision and brachytherapy with strontium-90 in 30 patients with carcinoma in situ and squamous cell carcinoma. After a follow-up between 3 months and 8 years (average 3 years) only one patient suffering from a squamous cell carcinoma developed a recurrence after 1 year. Two patients with squamous cell carcinoma developed telangiectasis, one patient developed glaucoma, and one patient developed a scleral ulcer.

Conjunctival melanomas are considered to be malignant tumors, the prognosis of which depends on various factors such as the size and thickness of the tumor and the number of recurrences following excision. The authors report on a 47-year-old woman who, years after local excision of a recurrent limbal conjunctival melanoma, developed an epibulbar melanoma far from the site of the original scar. The authors attribute this recurrence to lymphogenic propagation.

In a nine-year-old female cat, the diagnostic procedure, therapy and differential diagnoses of a rare, primary, malignant, epibulbar melanoma are presented. Post-operatively no recidivation or metastases occurred within 18 months.

In irradiated tissue, the farinfrared CO2 laser generates high temperatures of around 400 degrees C. Thermal damage can occur at the borders of the area being treated, but there are good hemostatic properties and thermal sterilization of the irradiated tissue. Photovaporization of papillomas has been occasionally proposed to achieve thermal inactivation of papilloma viruses and reduce the recurrence rates. Seventy-five cases of recurrent squamous papilloma were vaporized with a CO2 laser and followed-up for over 2 years. Only 2 recurrences were observed (20% have been reported after surgical excision). The procedure is quick, safe, easy to perform and well accepted by the patient. Good hemostatic properties, lack of cicatrication, and excellent cosmetic results are further advantages. Histological examination may be limited by thermal tissue damage.

The author reports on a 43-year-old patient who, having been treated for a conjunctival melanoma by local resection, presented 6 years later with a recurrent melanoma of a superficial spreading type, having a nodular and a flat component. While lamellar corneal excision was performed on the nodular component, the flat portion was treated with beta-contact radiation. The results are described and the argument for this therapy discussed.

The progression to malignancy of primary acquired melanosis of the conjunctiva with cytologic atypia is often insidious and may not be recognized clinically. Because of the bad prognosis of such melanomas, destruction of the intraepithelial lesion has been recommended. We have been freezing proliferative melanosis with the aid of a cryoprobe. A double freeze-thaw cycle at -70 degrees to -80 degrees was sufficient to destroy the epithelium and eradicate atypical melanocytes without serious complications. Focal nodules, arising in acquired melanosis representing invasive melanomas, however, should be excised initially. Cryotherapy may then be applied to the base and surroundings of the tumor.