Lommatzsch P K, Lommatzsch R E, Kirsch I, Fuhrmann P
Eye Hospital, Karl Marx University, Leipzig, German Democratic Republic.
Br J Ophthalmol. 1990 Oct;74(10):615-9. doi: 10.1136/bjo.74.10.615.
Eighty-one cases of conjunctival melanoma treated between 1960 and 1988 were studied to determine factors that might affect outcome in patients with such lesions. The therapeutic procedures performed were local excision (16), local excision followed by brachytherapy with Sr-90/Y-90 (32), local excision followed by cryotherapy with liquid nitrogen (16), brachytherapy with Sr-90/Y-90 (12), local excision followed by external beam irradiation (3), and local excision followed by brachytherapy and cryotherapy (2). The median follow-up period was 5.5 years (longest 26, shortest 1 year). Sixty two patients (76.5%) showed a complete regression of the melanoma, 19 (23.5%) developed recurrences, and 15 (18.5%) died from metastases. The melanomas had developed with almost equal frequency from a pre-existing naevus (25.9%), from primary acquired melanosis (25.9%), and 'de novo' (30.9%). Small tumours had a higher chance of regressing (80.6%) than larger ones (68.6%). The cumulative survival rate was 76% after five years and 60% after 10 years from any causes of death and 87.6% after five years and 76.3% after 10 years from deaths caused by metastases. Most deaths from metastases occurred within 5 years. At 88.5%, the cumulative survival rate of patients with small tumours (less than one quadrant of the bulbar conjunctiva and less than 2 mm thickness) was significantly higher than that of patients with larger tumours (more than one quadrant of the bulbar conjunctiva and/or more than 2 mm thickness) with 65% after eight years. Local excision followed by beta ray irradiation (Sr-90/Y-90) or cryotherapy can be recommended as the treatment of choice. Nevertheless the behaviour of conjunctival melanomas remains unpredictable in individual cases.
对1960年至1988年间治疗的81例结膜黑色素瘤患者进行了研究，以确定可能影响此类病变患者预后的因素。所采用的治疗方法包括局部切除（16例）、局部切除后行锶-90/钇-90近距离放疗（32例）、局部切除后行液氮冷冻治疗（16例）、锶-90/钇-90近距离放疗（12例）、局部切除后行外照射（3例）以及局部切除后行近距离放疗和冷冻治疗（2例）。中位随访期为5.5年（最长26年，最短1年）。62例患者（76.5%）黑色素瘤完全消退，19例（23.5%）复发，15例（18.5%）死于转移。黑色素瘤几乎以相同的频率由既往痣（25.9%）、原发性后天性黑素沉着症（25.9%）和“新发”（30.9%）发展而来。小肿瘤（直径小于2mm，累及不到一个象限的球结膜）比大肿瘤（直径大于2mm，累及超过一个象限的球结膜）有更高的消退几率（80.6%比68.6%）。任何原因导致的死亡，5年后的累积生存率为76%，10年后为60%；转移导致的死亡，5年后的累积生存率为87.6%，10年后为76.3%。大多数转移导致的死亡发生在5年内。小肿瘤患者（直径小于2mm，累及不到一个象限的球结膜）的累积生存率为88.5%，显著高于大肿瘤患者（直径大于2mm，累及超过一个象限的球结膜和/或厚度超过2mm），8年后为65%。可推荐局部切除后行β射线照射（锶-90/钇-90）或冷冻治疗作为首选治疗方法。然而，在个别病例中，结膜黑色素瘤的行为仍然不可预测。
