Brief report
Management of conjunctival and corneal melanoma with surgical excision, amniotic membrane allograft, and topical chemotherapy

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Abstract

PURPOSE: To illustrate a novel method of management for extensive conjunctival and corneal melanoma

METHODS: Interventional case report. A 40-year-old Caucasian woman presented with a large, diffuse conjunctival melanoma involving 6 clock hours of the limbus. The remaining bulbar conjunctiva and the entire corneal epithelium were affected by diffuse, flat melanosis.

RESULTS: The conjunctival melanoma was completely resected microsurgically in one piece without disrupting the tumor. The conjunctival melanosis was treated with double freeze–thaw cryotherapy. The extensive conjunctival defect, involving one-half of the bulbar conjunctiva, was reconstructed with an amniotic membrane allograft. The corneal melanosis was subsequently treated with topical mitomycin C eyedrops. At 8 months follow-up, the conjunctiva and the cornea were completely healed with resolution of all pigment and 20/20 visual acuity.

CONCLUSION: Preliminary evidence suggests that combined therapeutic approaches, consisting of extensive tumor removal, cryotherapy, amniotic membrane allograft, and topical mitomyin C, can be effective in the management of diffuse conjunctival and corneal melanoma arising from primary acquired melanosis.

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Case report

A 40-year-old Caucasian woman noted conjunctival pigmentation, LE, for 20 years. Ophthalmic consultation (T.A.) raised concern for conjunctival melanoma, and the patient was referred to the Ocular Oncology Service (C.L.S., J.A.S.) at Wills Eye Hospital.

On examination, her visual acuity was 20/20 in each eye. The only pertinent finding was extensive pigmentation, LE, involving the entire bulbar conjunctival surface from limbus to fornix in all four quadrants, suggestive of primary acquired

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Supported by the Eye Tumor Research Foundation, Philadelphia, Pennsylvania (C.L.S.) and the Paul Kayser International Award of Merit in Retina Research, Houston, Texas (J.A.S.).

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