Schmidt M, Maier M, Schmidt T, Klaehsen D, Merté R L
Augenklinik rechts der Isar, Technischen Universität München.
Klin Monbl Augenheilkd. 2001 Dec;218(12):805-9. doi: 10.1055/s-2001-19692.
About 70 % of the melanomas of the conjunctiva develop from an primary acquired melanosis (PAM) with atypia. This is the reason why excision, radiation, cryotherapy or a combination of them are proposed for therapy. But, if the acquired melanosis is very large, serious complications will be found with that treatment.
A 65-year-old woman has shown a large melanosis of the conjunctiva of her left eye. Biopsies, taken from different sites of the conjunctiva, have confirmed the diagnosis of an acquired melanosis of the conjunctiva with atypia. This has been the reason for our Mitomycin C 0.02 % therapy for one week. It has been repeated once again after half a year.
Atypia of the cells was shown in the upper cell layer of the conjunctiva after the first therapy. But after the second therapy no atypia of the cells was present within two years after the last treatment, examining several biopses.
Looking for an effective treatment without complications, a new therapy with Mitomycin C has been introduced in the last years. As it is not yet clearly known how to use Mitomycin to have maximal effectiveness with minimal complications, the reports about doses and frequency are differing a lot in the literature and are more often considerably lying over the introduced effective dose of our case. If Mitomycin is used in that low dosage and in that special application as shown, it could be a very efficient therapy with less complications.
约70%的结膜黑色素瘤由伴有异型性的原发性获得性黑色素沉着症（PAM）发展而来。这就是为何建议采用切除、放疗、冷冻疗法或联合使用这些方法进行治疗的原因。但是，如果获得性黑色素沉着症范围很大，采用上述治疗会出现严重并发症。
一名65岁女性左眼结膜出现大面积黑色素沉着症。从结膜不同部位取活检组织，确诊为伴有异型性的结膜获得性黑色素沉着症。这就是我们采用0.02%丝裂霉素C治疗一周的原因。半年后再次重复治疗。
首次治疗后，结膜上层细胞出现细胞异型性。但第二次治疗后，在最后一次治疗后的两年内，经多次活检检查，未发现细胞异型性。
为寻求一种无并发症的有效治疗方法，近年来引入了丝裂霉素C新疗法。由于目前尚不清楚如何使用丝裂霉素才能在并发症最少的情况下达到最大疗效，文献中关于剂量和频率的报道差异很大，且往往大大超过我们病例中所采用的有效剂量。如果按照所示的低剂量和特殊应用方式使用丝裂霉素，可能是一种并发症较少的高效治疗方法。
