Dr. Orwa Nasser MD MPH - Conjunctival Melanoma

Conjunctival Melanoma

Conjunctival melanoma is a rare but serious form of eye cancer that develops in the conjunctiva, the thin mucous membrane covering the white part of the eye and lining the inside of the eyelids. It arises from melanocytes, which are pigment-producing cells within the conjunctival tissue. Although uncommon, this condition can be life-threatening if not diagnosed and treated early. Conjunctival melanoma may invade nearby tissues and spread to other parts of the body if not properly managed. It most commonly affects adults and rarely occurs in children.

Symptoms:

·    Early stages may not cause noticeable symptoms.

·    A new pigmented spot on the white of the eye or inner eyelid.

·    A brown, black, or non-pigmented lesion that appears raised or thickened.

·    Changes in size, color, or shape of an existing conjunctival nevus.

·    Localized irritation or awareness of a surface growth.

·    Occasionally mild redness or discomfort.

·    Because these signs may resemble benign conditions, careful examination is important.

Causes:

·    Conjunctival melanoma develops due to uncontrolled growth of melanocytes in the conjunctiva.

·    Genetic mutations and ultraviolet light exposure may contribute to its development.

·    It may arise from primary acquired melanosis, especially when cellular atypia is present.

·    Transformation of a conjunctival nevus into melanoma can also occur.

·    The condition is not contagious and does not spread from person to person.

Diagnosis and Tests:

·    Diagnosis begins with a comprehensive eye examination.

·    Slit-lamp examination allows detailed inspection of suspicious conjunctival lesions.

·    A biopsy is performed to confirm malignancy by examining tissue under a microscope.

·    Additional imaging or systemic evaluation may be required to assess local invasion or metastasis.

·    Early and accurate diagnosis significantly improves treatment outcomes.

Management and Treatment:

·    Surgical Removal:

o   Complete surgical excision with clear margins is the primary treatment approach.

o   The goal is to remove all malignant tissue while preserving as much healthy tissue as possible.

·    Adjunctive Therapies:

o   Cryotherapy may be applied to destroy remaining microscopic tumor cells.

o   Topical chemotherapy may reduce the risk of recurrence in selected cases.

o   Radiation therapy may be considered for specific tumor types or incomplete excision.

o   Advanced cases may require systemic therapy such as immunotherapy or targeted treatments.

o   Management often involves collaboration with ocular oncology specialists.

Prognosis:

·    Prognosis depends on tumor size, depth, location, and whether spread has occurred.

·    Early detection and complete removal improve survival and visual outcomes.

·    Recurrence is possible, requiring long-term follow-up and monitoring.

·    Metastasis to regional lymph nodes or distant organs can occur in advanced cases.

Prevention:

·    There is no guaranteed method to prevent conjunctival melanoma.

·    Regular eye examinations can help detect suspicious lesions early.

·    Protecting the eyes from ultraviolet exposure with sunglasses may reduce risk.

·    Individuals with primary acquired melanosis or conjunctival nevi should undergo regular monitoring.

When Should I See My Healthcare Provider? Seek evaluation if you notice a new or changing spot on the white of your eye or inner eyelid.

When Should I Go to the Emergency Room? Seek emergency care if you experience sudden vision changes, rapid lesion growth, bleeding, or severe eye pain.

What Questions Should I Ask My Healthcare Provider?

    ·    Is this lesion suspicious for melanoma?

    ·    Do I need a biopsy?

    ·    What treatment options are available?

    ·    What is my risk of recurrence?

    ·    How often should I be monitored?

Key Takeaways:

    ·    Conjunctival melanoma is a rare but serious eye cancer.

    ·    It arises from pigment-producing melanocytes in the conjunctiva.

    ·    New or changing pigmented lesions should be evaluated promptly.

    ·    Treatment typically involves surgical excision with adjunctive therapy.

    ·    Long-term follow-up is essential due to recurrence risk.