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5 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
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.
| Setting | Approach | Guideline |
|---|---|---|
| Localised | No-touch excision with cryotherapy to the margins and topical mitomycin or interferon for associated melanosis; sentinel node biopsy in selected cases. | not mapped |
| Metastatic | Treated as on the melanoma page: BRAF and MEK inhibitors when mutated, checkpoint inhibitors otherwise. | not mapped |