Conjunctival melanoma with orbital invasion and liver metastasis managed with systemic immune checkpoint inhibitor therapy

A 60-year-old Caucasian female was referred for biopsy-proven amelanotic orbito-conjunctival melanoma. Map biopsies revealed residual invasive melanoma on the deep tarsal margin at the site of previous surgery. Repeat excisions were required after recurrence was detected following 3 months and 7 months. Positron emission tomography scan detected liver metastasis and additional orbito-conjunctival melanoma recurrence. Biomarker testing showed NRAS mutation without BRAF or c-KIT mutations and without PD-L1 expression. Systemic checkpoint inhibitor therapy was initiated with regression of both the orbito-conjunctival melanoma and liver metastasis. Invasive, non resectable orbito-conjunctival melanoma with liver metastasis can demonstrate a response to systemic checkpoint inhibitor therapy.

Comparison of posterior lamellar resection versus lumpectomy for initial management of localized tarsal conjunctival sebaceous carcinoma in 54 cases

Purpose: Comparison of outcomes of localized eyelid sebaceous carcinoma (American Joint Committee on Cancer (AJCC) 8th edition categories T1, T2, T3) following initial management with posterior lamellar resection (PLR) versus (vs) lumpectomy (nonposterior lamellar resection, non-PLR). Methods: This was a retrospective, comparative, interventional case series. Of 54 patients, 26 were managed by PLR and 28 by nonPLR. The main outcome measures were vision loss, orbital exenteration, lymph node metastasis, and remote metastasis were the main outcome measures. Results: A comparison of PLR vs nonPLR revealed no difference in mean age at presentation (70 vs 72 years), race (Caucasian 100% vs nonCaucasian 93%), gender (female 54% vs male 71%), entering mean visual acuity (20/30 vs 20/50), or corneal involvement (23% vs 11%). There was significant difference in clinical features with PLR demonstrating greater mean basal diameter (21 mm vs 12 mm, P = 0.004), and positive margins were seen more frequently in PLR (69% vs 46%). There was significantly less number of surgical procedures in PLR to achieve complete tumor control (1.7 vs 2.5, P = 0.001). Outcomes at mean 55 months follow-up revealed significantly better control with PLR (vs nonPLR) with fewer orbital exenterations (15% vs 43%, P = 0.038), fewer lymph node, and systemic metastases (0% vs 39%, P < 0.001). There was no significant difference in final mean visual acuity (20/60 vs 20/200). Conclusion: For eyelid sebaceous carcinoma, the initial management is critical to the patient's outcome. PLR demonstrates superior outcomes with regard to preservation of visual acuity and avoidance of exenterations, lymph node metastases, and systemic metastases compared to patients managed with other techniques.