|Year : 1960 | Volume
| Issue : 4 | Page : 92-93
Malignant melanoma of the limbus
BK Phatak, OM Satyendran
Sarojini Devi Hospital and Institute Of Opthalmology and Otolaryngology,Hyderabad, India
|Date of Web Publication||5-May-2008|
B K Phatak
Sarojini Devi Hospital and Institute Of Opthalmology and Otolaryngology,Hyderabad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Phatak B K, Satyendran O M. Malignant melanoma of the limbus. Indian J Ophthalmol 1960;8:92-3
Malignant pigmented neoplasms are seen rarely in this hospital. During the past twelve months six thousand inpatients and over thirty-six thousand out-patients were treated in the eye department. During this period the pathology register records only two other cases of malignant melanomata of the eye and its adnexa.
The patient, a man named Chenniah, aged 60 cultivator by profession complained of a growth in his right eye. He had noticed a dark spot in the same eye since birth but during th past eight months it had begun to grow rapidly.
The tumour was a brownish-black cylindrical mass astride the limbos on the temporal side and protruded forwards between the lid margins to a length of 18 nun [Figure - 1],[Figure - 2]. Its base was roughly circular, about i cm across, extending from the outer third of the cornea across the limbos to the bulbar conjunctiva. It presented a shining smooth lobulated surface. About 2 min of the cornea around the base had a brownish black appearance. Prominent tortuous conjunctival blood vessels led to the base of the neoplasm. The visual acuity in the eye was 6/60. Because of this, considerable persuasion had to be exercised before the patient consented to the removal of the eye.
Histological sections of the eyeball were made in the parasagital plane. The cellular details were obscured by heavy dark brown granular pigment. Bleaching of the pigment revealed epitheliod type cells in a sheet like arrangement [Figure - 3]. The cytoplasmic outlines were indistinct. The nuclei which were clearly demarcated contained one or two nucleoli. The overlying stratified epithelium whose basement membrane was intact, did not present any abnormality [Figure - 4]. 1nfelaiorly, adjacent to the base of the neoplasm the corneal epithelium presented changes similar to those of precancerous melanosis [Figure - 5]. There was intraepithelial proliferation of cells with cytoplasmic vacuolation and containing granular dark-brown pigment. The cell; were arranged in small groups within the epithelium.
Reese, (1953) states that a malignant me!anoma of naevus origin is a localized, elevated aid sometimes pedunculated single or multiple tumour mass showing varying amounts of pigmentation and composed of large nucleolated cells with well demarcated borders. But, according to him, it is a rare occurrence for a pre-existing naevus to develop into a malignant tumour. The history, clinical signs and the lustological features in this case favour the diagnosis of a malignant melanoma arising from a preexisting nevus. The precancerous changes are seen only in the epithelium adjacent to the base of the neoplasm and not within the epithelium overlying it. It is probable that these changes were excited concurrently with or after the malignant transformation of the naevus. A case in which one eye presented a malignant melanoma at the limbo, on one side and exhibited pre-cancerous changes in the corneal epithelium on the opposite side has been reported by Schofield. (1958).
Although the tumour had been growing for eight months and had attained a length of 18 mm only the anterior layers of the corneal stroma were infiltrated, the globe and its contents remaining uninvaded. Whether precancerous changes were present in the bulbar conjunctiva was not ascertained by sections in the horizontal plane. As an enucleation of the eye-ball was carried out instead of an exenteration of the orbit (Reese 1953) it is hoped that the conjunctiva removed with the globe has been adequate.
| References|| |
Duke Elder S. (1939) Text Book of Ophthalmology-" P. 1807, Kimpton, London,
Reese, A. B. (1953) "Tumours of the Eye" p. 330, Paul B. Hoeber, U.S.A.
Schofield, P. B. (1958)"Brit. J. Ophthal", 42, 99.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]