|Year : 1985 | Volume
| Issue : 4 | Page : 259-261
Malignant melanoma of conjunctiva following surgical excision of naevus
SM Betharia, S Vashisht, BR Kalra
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
S M Betharia
Dr. Rajendra Prasad Centre for Ophthalmic Sciences AIIMS, New Delhi-29
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Betharia S M, Vashisht S, Kalra B R. Malignant melanoma of conjunctiva following surgical excision of naevus. Indian J Ophthalmol 1985;33:259-61
Malignant melanoma of conjunctiva is a rare condition and we are reporting a case here with cervical and intracranial metastasis and the patient is still alive.
| Case report|| |
48 years female was admitted on 22.8.80 with the complaint of a mass under the left upper lid for 2 years duration with rapid growth for last 3 months. There was loss of all useful vision in left eye for last 1 month. There was past history of excision of a naevus in the limbal region which was of 12 years duration which recurred after 1 month after excision. She was admitted in the past as a case of malignant melanoma of limbal region with metastasis in the cervical lymph node and was considered for exenteration which the patient refused and radiotherapy was done. The swelling subsided after 15 days of radiation and recurred again. On local examination the right eye was normal. The left eye had only perception of light. There was a complete mechanical ptosis in left eye and a total blackish discolouration of both the upper and lower lids. A naevus with hair was present in the lateral part of the upper lid. [Figure - 1] A soft black lobulated mass was present under the upper lid arising from the upper palpebral conjunctiva which showed small punctate erosions leading to bleeding and was extending back upto superior fornix [Figure - 1]. The cornea was oedematous and showed superficial vascularization. Anterior chamber had hyphema with the movement of the globe. There was a small nodule at the limbus on the corneal side at 4 O'clock position. The iris pattern was lost and the pupil was not reacting to light. The lens was cataractous. The digital tension was high. The positive finding on general examination was the presence of a linear scar of about 2 cm in the cervical regio'.i on the left side. All other systems and skeletal survey was normal.
Investigations-Routine haeniogram and urine examination was normal. The E.S.R. was 58 mm at the end of 1st hour. The random blood sugar was 103 mgs per cent. Radiological examination of skull, orbits, optic foramen and superior orbital fissures were normal. The C.A.T. Scan showed an area of increased attenuation in the right parasellar and basofrontal region [Figure - 2]. The histopathology of the cervical lymph node showed groups of polyhedral melanin loaded cells whose unclear details was obscured [Figure - 3]. The findings were consisent with metastatic malignant melanoma. The blood proteins were 7.2 gms. The albumin was 3.3 gms % and globulin was 3.9%. The total bilirubin was normal. The serum alkaline phosphatase was 30 K.A.U./l00 ml. and acid phosphatase was 6.5 K.A.U./100 ml. Total exenteration was done on 31 8.80 which showed no bony involvement.
| Discussion|| |
The conjunctival melanoma is a rare condition and usually develops either spontaneously or from the previous benign naevus. Our case had neavus of conjunctiva of 12 years duration and had a recurrence after l month of excision. This surgical trauma was the precipitating factor for malignancy in our case. This patient falls well within the reported age group between 40 to 60 years. The spread in our case was through lymphatics and vascular route and there was metastasis to the cervical lymph nodes and brain.
The histopathology of the lesion and of cervical lymph node confirmed the diagnosis of epithelioid variety of malignant melanoma showing rich vascularization with areas of necrosis.
In series reported by Jay out of 97 malignant melanomas 44 were composed of epithelioid cells, 7 of spindle cells, 1 of naevoid cells, 32 showed mixture of all types of cells, 13 had a mixture of epithelioid and spindle cells while 22 contained giant cells.
Epithelioid variety had a worst prognosis whereas the spindle cell variety has the best prognosis. Palpebral conjunctival involvement and the involvement of the caruncle has the worst prognosis.
Penetration of the globe is rare and late. Our patient had hyphema indicating intraocular spread probably through the region of Schiemn's canal.
Of the various surgical treatment described such as local excision, enucleation and exenteration the last one seems to be the best and safest. The death results within a period of I to 2 years. However, these tumors are unique and they follow no set of rules. Our patient is still alive after 5 years of exenteration. The role of radiotherapy is controversial. Generally these cases are radioresistant except' the cases arising denovo respond well to radiotherapy.
| Summary|| |
A case of malignant melanoma of conjunctiva following surgical execision of naevus with cervical and brain metastasis is reported. The role of orbital exenteration and radiotherapy is discussed. The patient still alive after 5 years of exenteration.
| References|| |
Bodian, K. J., 1963, Trans. Amer. Acad. Ophthalmol. 67 :723.
Jay, B., 1965, Brit. J. Ophthalmol., 49 : 169.
Tuovinen, J.S., 1962, Acta Ophthalmol (Kbh) 40: 149.
[Figure - 1], [Figure - 2], [Figure - 3]