Unit of Ocular Oncology, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy.
Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy.
Eur J Ophthalmol. 2021 Nov;31(6):NP71-NP74. doi: 10.1177/1120672120944027. Epub 2020 Jul 16.
To report a case of a large conjunctival melanoma (CM) successfully treated with surgical resection and pre- and postoperative topical mitomycin C (MMC).
This is a single observational case report.
A 58-year-old man was referred to us for a large pigmented conjunctival lesion of the right eye. Slit lamp examination revealed an extensive pigmented lesion diffusely involving the temporal bulbar conjunctiva, with multifocal intensely dark areas and an elevated limbal component extending on the corneal surface. The remaining bulbar and forniceal conjunctiva was not involved. The lesion was clinically diagnosed as CM. Clinical examination and head and neck ultrasonography did not show regional lymphadenopathy. The patient was treated with neoadjuvant topical MMC 0.04% four times a day for 3 weeks. At the end of MMC therapy we observed a reduction in pigmentation and thickness of the lesion. Subsequently, the patient underwent surgical excision of the lesion with "no touch technique," double freeze-thaw cryotherapy of the margins and reconstruction of the tissue defect with amniotic membrane graft. Histopathologic examination of the specimen confirmed the presence of CM, surrounded by primary acquired melanosis with atypia. The excision margins were positive for tumor involvement, so we decided to perform an adjuvant treatment with other four cycles of topical MMC.
The patient was closely followed-up after the treatment, without any local or distant recurrence at 32 months.
报告一例成功接受手术切除联合术前和术后局部应用丝裂霉素 C（MMC）治疗的巨大结膜黑色素瘤（CM）病例。
这是一项单病例观察研究。
一名 58 岁男性因右眼大的色素性结膜病变就诊于我院。裂隙灯检查显示广泛的色素性病变弥漫累及颞侧球结膜，有多处暗区且有一个隆起的缘部成分延伸至角膜表面。其余的球结膜和穹窿部结膜未受累。病变临床诊断为 CM。临床检查和头颈部超声检查未发现区域性淋巴结病。患者接受了新辅助治疗，每日 4 次局部应用 0.04% MMC 治疗 3 周。在 MMC 治疗结束时，我们观察到病变的色素沉着和厚度减少。随后，患者接受了病变的手术切除，采用“无接触技术”，边缘进行双次冻融冷冻治疗，并使用羊膜移植物重建组织缺损。标本的组织病理学检查证实存在 CM，周围伴有原发性获得性黑色素沉着伴异型性。切除边缘有肿瘤累及，因此我们决定进行辅助治疗，再进行 4 个周期的局部 MMC 治疗。
患者在治疗后进行了密切随访，32 个月时无局部或远处复发。
