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Conjunctival melanoma is a rare melanoma of the clear membrane over the white of the eye, usually growing out of a flat brown patch called primary acquired melanosis. It is removed with a margin and the edges frozen or treated with chemotherapy drops; about one in five spread within five years, and advanced disease is treated like skin melanoma with targeted or immune drugs.
Conjunctival melanoma is a mucosal-surface melanoma of the eye, distinct from uveal melanoma in origin, genetics and behaviour and classified with the conjunctival tumours in the WHO eye classification. In 382 consecutive patients, the melanoma arose from primary acquired melanosis in 74 percent, from a pre-existing naevus in 7 percent and de novo in 19 percent; melanoma-related metastasis at five (ten) years occurred in 19 (25) percent of tumours arising from primary acquired melanosis, 10 (26) percent from naevus and 35 (49) percent de novo, and de novo origin and palpebral location predicted metastasis (Shields 2011). In Denmark the incidence was 0.5 per million a year and rising, with BRAF mutations in 39 of 111 tumours (35 percent) (Acta Ophthalmologica 2016).
How it differs from its parent: it behaves and mutates like cutaneous rather than uveal melanoma (BRAF, NRAS, NF1 rather than GNAQ and GNA11), it spreads to regional lymph nodes first, and its local treatment is ophthalmic surgery with adjuvant cryotherapy or topical chemotherapy rather than wide skin excision.
How common: about 0.5 per million a year (Acta Ophthalmologica 2016).
Treatment: excision without touching the tumour, with cryotherapy to the margins and topical mitomycin or interferon for the associated melanosis, as in the ophthalmic series; sentinel node biopsy in selected cases; metastatic disease treated as on the melanoma page with BRAF and MEK inhibitors when mutated and checkpoint inhibitors otherwise (Shields 2011 for the surgical series).
About 0.5 cases per million a year in Denmark, rising over 1960 to 2012 (Acta Ophthalmologica 2016); the largest clinical series holds 382 consecutive patients (Shields 2011). It is separate from uveal melanoma, which GLOBOCAN also does not count apart.
Uveal melanoma arises in the pigmented choroid and ciliary body, retinoblastoma in the retina of infants; the eye has no lymphatics, so spread is through the blood (uveal melanoma almost always to the liver).
No lymphatic drainage: spread is haematogenous (uveal melanoma to the liver) or along the optic nerve (retinoblastoma).
Same organ: Optic pathway glioma, Uveal melanoma, Retinoblastoma
No-touch excision with cryotherapy to the margins and topical mitomycin or interferon for associated melanosis; sentinel node biopsy in selected cases.
Treated as on the melanoma page: BRAF and MEK inhibitors when mutated, checkpoint inhibitors otherwise.
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Query for this cancer: (TITLE:"Conjunctival melanoma" OR ABSTRACT:"Conjunctival melanoma" OR TITLE:"Melanoma of the conjunctiva" OR ABSTRACT:"Melanoma of the conjunctiva" OR TITLE:"Ocular surface melanoma" OR ABSTRACT:"Ocular surface melanoma" OR TITLE:"Conjunctival malignant melanoma" OR ABSTRACT:"Conjunctival malignant melanoma") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Conjunctival melanoma, not a curated reading list.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, and the expert centres with trials on record.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Fainting, near-fainting, or an irregular or racing heartbeat; several kinase inhibitors prolong the QT interval and the labels require ECG and electrolyte monitoring.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
Immunotherapy can attack hormone-producing glands: most often the thyroid (usually ending in an under-active thyroid needing lifelong tablets), and less often the pituitary (hypophysitis) or adrenal glands, which can be life-threatening if missed.
See all on the product pages:DabrafenibMitomycin CNivolumabPembrolizumabTrametinib·Printable cards in the navigator
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