Título

WHEN IN DOUBT CUT IT OUT: ZERO TOLERANCE FOR CONJUNCTIVAL MELANOMA SUSPICION

Introdução

A 57 year-old caucasian male patient presented with a 2 months history of a painless enlarging pink lesion on the surface of his right eye. There were no visual symptoms nor any previous ocular surgery or trauma. Examination revealed a nonpigmented vascularized conjunctival nodule sorrounded by a pigmented area without any scleral attachment, leading to a diagnostic hypothesis of conjunctival melanoma with na amelanotic component. Differential diagnosis could include a foreign body-induced granuloma, pyogenic granuloma, conjunctival intraepithelial neoplasm. The conjunctival component was surgically removed performing the wide "no touch" technique of conjunctivectomy, achieving tumor-free margins of 5 mm, and followed by double freeze-thaw cryotherapy. Closure was achieved by amniotic membrane transplantation.

Métodos

A conjunctival melanoma usually presents as a pigmented nodular lesion located at the limbus over or adjacent to an area of PAM in caucasian elderly population. Pigmentation, nodularity, changes in size, prominent feeder vessels and unusual location , should raise the suspicion of a malignant lesion. However, conjunctival melanoma may uncommonly be amelanotic or reddish-pink in color, simulating a malignant epithelial neoplasm, such as conjunctival intraepithelial neoplasia or squamous cell carcinoma, or a more benign inflammatory process, such as nodular episcleritis or pyogenic granuloma. The presence of cysts in an amelanotic lesion favors a diagnosis of amelanotic nevus. A careful evaluation at the slit lamp should be done before surgical excision and may help to determinate the margins of amelanotic lesions.

Resultados

N/A

Conclusões

When prognosis is concerned, the most important aspect of the treatment is a proper first surgical intervention. A “no touch” technique excision should be performed with wide margins (at least 4 mm) from the apparent lesion. Tumor cells should not be irrigated, only normal conjunctiva should be manipulated with instruments; a clean set of instruments should be used after resection of the tumor. It is crucial to complement surgical excision with cryotherapy (double freeze-thaw) at the conjunctival margins. Adjunctive topical chemotherapy, typically with mitomycin C, can be used for recurrent or very extensive lesions.

Palavras Chave

Melanoma, tumor, conjuctival tumor, conjunctival melanoma

Arquivos