Therapeutic outcome of patients suffering from malignant melanomas of the conjunctiva

Melanoma of the conjunctiva (mucous membrane lining the eyelids and front surface of the eyeball) occurs in only about 2 percent of eye melanomas. Melanoma is a malignant neoplasm composed of cells able to produce melanin, a naturally occurring pigment found in the iris and choroid of the eye. A study was undertaken of 81 patients treated between 1960 and 1988 for conjunctival melanoma; the goal of the research was to identify factors that influence the disease outcome. The average follow-up lasted 5.5 years, with 54.3 percent of patients followed for more than five years. The average age of the patients at the time of initial examination was 55 years. In 73 percent of patients the conjunctiva overlying the eyeball was the site of the melanoma. Treatment included local excision in 16 patients; local excision and brachytherapy (placement of radioactive sources in contact with the malignant tissue) in 32 patients; local excision with cryotherapy (freezing) in 16; brachytherapy in 12; beam radiotherapy in three; and local excision with brachytherapy and cryotherapy in two patients. Complete regression of melanoma was achieved in 62 patients (76.5 percent); there was a recurrence in 19 patients (23.5 percent); and 15 (18.5 percent) died from metastasis (spread of the cancer). Most deaths from metastasis occurred within five years. Five-year survival (using death from any cause) was 76 percent, and 10-year survival was 60 percent. The survival rate after eight years for patients with small tumors was 88.5 percent, significantly higher than the survival rate (65 percent) for patients with larger tumors. The recommended treatment is local excision followed by beta-ray brachytherapy or cryotherapy. It should be noted that the course and progression of conjunctival melanomas is unpredictable. (Consumer Summary produced by Reliance Medical Information, Inc.)