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A case of a 16-year-old male with xeroderma pigmentosum (XP) who presented with multiple pigmented and nonpigmented conjunctival lesions in both eyes is reported. He had a keratinized lesion at the limbus and a pigmented lesion in bulbar conjunctiva in the left eye and multiple pigmented bulbar conjunctival lesions and a keratinized limbal nodule in the right eye. Excision biopsy confirmed the diagnosis of ocular surface squamous neoplasia (OSSN) and conjunctival intraepithelial melanocytic neoplasia-2 (CIMN-2) in the right eye and OSSN and conjunctival melanoma in situ (CIMN-5) in the left eye. Two malignant conjunctival lesions occurring simultaneously in the same eye of a patient with XP have not been reported earlier.
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RESUMEN El objetivo de este reporte de caso fue identificar las características de un nevo abultado conjuntival en una paciente femenina de 72 años de edad. Se muestran las pruebas complementarias realizadas para llegar al diagnóstico de melanoma conjuntival, que consiste en un tumor poco frecuente, el cual constituye el 2 por ciento de todos los tumores del ojo. Las células involucradas son los melanocitos del epitelio conjuntival. Un factor de riesgo para esta entidad puede ser la exposición a la luz ultravioleta; sin embargo, esto no está bien determinado. La mayoría de los casos se originan de una melanosis adquirida primaria (50-70 por ciento). La presentación más común es una lesión pigmentada, unilateral, elevada, gruesa, con vasos sanguíneos y áreas de melanosis a su alrededor. Su diagnóstico se realiza con la sospecha clínica que se confirma con el estudio histopatológico. El tratamiento en la actualidad es la excisión local, seguida de crioterapia, radioterapia o quimioterapia. La enfermedad matastásica ocurre en el 11 - 42 por ciento y en el 20 - 52 por ciento de los pacientes en un seguimiento de 5 y 10 años, respectivamente(AU)
ABSTRACT The objective of this case report is to describe the characteristics of a conjunctival bulging nevus in a 72-year-old female patient and the complementary tests that were performed to reach the diagnosis of conjunctival melanoma. Conjunctival melanoma is a rare tumor, which account for 2 percent of all eye tumors. The cells involved are the melanocytes of the conjunctival epithelium. A risk factor for this entity may be exposure to ultraviolet light. However, it has not been precisely described. Most cases originate from a primary acquired melanosis (50-70 percent). The most common presentation is a pigmented, unilateral, elevated, thick, lesion with blood vessels and areas of melanosis around it. Its diagnosis is made with the clinical suspicion confirmed with the histopathological study. Current treatment is local excision, followed by cryotherapy, radiotherapy, or chemotherapy. Metastatic disease occurs in 11-42 percent and 20-52 percent of patients in a 5-year and 10-year follow-up, respectively(AU)
Subject(s)
Humans , Female , Aged , Ophthalmoscopy/methods , Eye Neoplasms/epidemiology , Melanoma/surgery , Nevus, Pigmented/diagnostic imagingABSTRACT
Objective To study the significance of metastasis associated genes nm23,p53 and S100A4 in the development of conjunctival melanoma metastasis.Methods Conjunctival melanoma tissue specimens were collected from 42 cases of conjunctival melanoma patients in Henan Eye Hospital from July 2015 to November 2016,meanwhile 30 cases of conjunctival nevus tissue samples served as control group under the informed consent.The expressions of nm23,p53 and S100A4 were detected in conjunctival melanoma group and control group by Western blot and immunohistochemical method.The relationship between the clinical and pathological features of nm23,p53 and S100A4 with conjunctival melanoma patients with lymph nodes metastasis were analyzed.Results Western blot assay showed that the expression level of nm23 in conjunctival melanoma group was lower than that in the control group,with a significant difference between them (P＜0.05);the expression level of p53 and S100A4 in conjunctival melanoma group was significantly higher than those in the control group (both at P＜0.05).Immunohistochemistry showed that nm23 and S100A4 appeared claybank in cytoplasm,while p53 appeared red in cell nucleus.The positive rate of nm23 protein expression in conjunctival melanoma group was significantly lower than that in the control group (14.3％ vs.53.3％,P＜0.05).The positive rate of p53 expression in conjunctival melanoma group was significantly higher than that in the control group (54.8％ vs.6.7％,P＜0.05).The positive rate of S100A4 expression in the conjunctival melanoma group was significantly higher than that in the control group (59.5％ vs.6.7％,P＜0.05).There were no difference in nm23,p53 and S100A4 protein expression positive rate between various gender groups,various age groups and various ulcer groups (all at P＞0.05).There were siginificant differences in nm23,p53 and S100A4 protein expression positive rate between various sclera invasion groups and various distant metastasis groups (all at P＜0.05).Conclusions Expression of nm23,p53 and S100A4 may play an important role in the invasion and metastasis of conjunctival melanoma,which may be the main reference index for the diagnosis and treatment.
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Conjunctival malignant melanoma (CMM) is rare and can be life threatening. Management of CMM is by surgical excision of the tumor. Non-surgical treatment consists of topical eye drops especially in diffuse and multifocal malignant melanoma. Interferon is reported as an effective agent of CMM treatment. The purpose of this study is to evaluate the effect of Interferon alfa 2a in diffuse recurrent conjunctival melanoma and follow up of primary conjunctival melanoma after treatment with Interferon alfa 2a. In this paper we are going to present a case of CMM in bulbar conjunctiva and 12 years of follow-up. Once the CMM was suspected, surgical removal of the affected area was performed and the subsequent biopsy resulted positive. Ten years later CMM reappeared in the same place and second surgery was performed. Two years later a second recurrence of the melanoma occurred at the same place as before. In order to avoid another surgery a treatment with topical interferon alpha 2 a 1 MIU/mL, 4 drops/day for 3 months was performed instead. Following 15 months of this treatment no sign of conjunctival melanoma came into sight.
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PURPOSE: To report a patient with malignant conjunctival melanoma with extensive corneal invasive growth. METHODS: A 63-year-old woman with 9 x 7 mm sized dark brown colored conjunctival mass with extensive corneal invasive growth over a 3-month history was seen. The mass was removed and biopsy was done. Fontana-Masson, S-100 protein, and HMB stainings were used to confirm the diagnosis of malignant melanoma. RESULTS: The tumor was easily separated from the corneal surface and adjacent conjunctiva was excised. Fontana-Masson, S-100 protein, and HMB stainings revealed corneally-displaced malignant conjunctival melanoma. There was no evidence of metastasis. CONCLUSIONS: Corneally displaced malignant conjunctival melanoma was very rare. A good surgical result was obtained with its removal.
Subject(s)
Female , Humans , BiopsyABSTRACT
Primary malignant melanoma of the conjunctiva represents less than 2% of ocular melanomas and less than 1%of malignant tumors of the eye and usually derives from PAM(Primary acquired melanosis). Conjunctival melanoma spreads initially via lymphatics to the regional lymph nodes and eventually to the other organs in the body. Recently, except for advanced unresectable cases, conjunctival melanoma is treated by excision of the mass combined with cryotherapy. We report a case of conservative treatment in a patient who presented recurred conjunctival melanoma, along with the review of literatures.