Kurli Madhavi, Finger Paul T
The New York Eye Cancer Center, The Fifth Floor, 115 East 61st Street, New York, NY 10021, USA.
Graefes Arch Clin Exp Ophthalmol. 2005 Nov;243(11):1108-14. doi: 10.1007/s00417-004-1080-y. Epub 2005 Jun 7.
To report 12-year follow-up experience with topical mitomycin chemotherapy for diffuse and multifocal primary acquired melanosis (PAM) with atypia and conjunctival melanoma.
Interventional case series of 16 patients. Mitomycin was a primary treatment for residual epithelial disease in ten patients (eight with PAM with atypia and two with conjunctival melanoma) and as an adjuvant to excision and cryotherapy in six with conjunctival malignant melanoma. Primary treatments consisted of mitomycin 0.04% qid for 28 days (two 14-day cycles) and for 7 consecutive days as adjuvant therapy. Patients were followed for both local recurrence and metastatic disease.
Sixteen patients were followed for a mean 81 months (range 13-144 months) after treatment. All tumors responded to chemotherapy. Recurrence was noted in eight (three adjuvant and five primary treatment patients). Three underwent orbital exenteration. The remaining five were treated conservatively. The mean time to recurrence was 36.9 months. The short-term mitomycin-related complications included transient keratoconjunctivitis (n=14), severe keratoconjunctivitis (n=1) and one corneal abrasion with scar formation. The long-term complications included pannus (n=2) and corneal haze (n=1). Visual acuity was maintained within two lines in 14 patients (including measurements just prior to exenteration). Three patients died, one of metastatic conjunctival melanoma.
Conjunctival melanoma and PAM responded to mitomycin 0.04% topical chemotherapy; subepithelial nests appeared resistant to treatment. Treatment-related complications were acceptable. In this series, as primary and adjuvant therapy, topical mitomycin yielded an overall recurrence rate of 50%.
报告对伴有异型性的弥漫性和多灶性原发性获得性黑素沉着症（PAM）及结膜黑色素瘤采用丝裂霉素局部化疗的12年随访经验。
16例患者的介入性病例系列。丝裂霉素是10例患者（8例伴有异型性的PAM和2例结膜黑色素瘤）残留上皮病变的主要治疗方法，6例结膜恶性黑色素瘤患者在切除和冷冻治疗后作为辅助治疗。主要治疗包括0.04%丝裂霉素每日4次，共28天（两个14天周期），作为辅助治疗时连续使用7天。对患者进行局部复发和转移性疾病的随访。
16例患者在治疗后平均随访81个月（范围13 - 144个月）。所有肿瘤对化疗均有反应。8例出现复发（3例辅助治疗患者和5例主要治疗患者）。3例行眼眶内容物剜除术。其余5例采用保守治疗。复发的平均时间为36.9个月。丝裂霉素相关的短期并发症包括短暂性角结膜炎（n = 14）、严重角结膜炎（n = 1）和1例角膜擦伤伴瘢痕形成。长期并发症包括血管翳（n = 2）和角膜混浊（n = 1）。14例患者（包括剜除术前的测量）视力保持在两行以内。3例患者死亡，1例死于转移性结膜黑色素瘤。
结膜黑色素瘤和PAM对0.04%丝裂霉素局部化疗有反应；上皮下巢对治疗似乎有抗性。与治疗相关的并发症是可接受的。在本系列中，作为主要和辅助治疗，局部丝裂霉素的总复发率为50%。
