Matsuo Toshihiko, Ogata Takeshi, Waki Takahiro, Tanaka Takehiro, Tachibana Kota, Fuji Tomokazu, Adachi Takuya, Yamasaki Osamu
Regenerative and Reconstructive Medicine (Ophthalmology), Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama City 700-8558, Japan.
Department of Ophthalmology, Okayama University Hospital, Okayama City 700-8558, Japan.
J Med Cases. 2025 Jan;16(1):28-36. doi: 10.14740/jmc4351. Epub 2024 Dec 1.
Conjunctival malignant melanoma is extremely rare, with no standard of care established at moment. Here we report a 65-year-old woman, as a hepatitis B virus (HBV) carrier, who presented concurrently a liver mass and lower bulbar conjunctival pigmented lesions in the right eye. Needle liver biopsy and excisional conjunctival biopsy showed hepatocellular carcinoma and conjunctival malignant melanoma , respectively. The priority was given to segmental liver resection for hepatocellular carcinoma after transcatheter arterial chemoembolization. In 1 year, she underwent second and third resection of bulbar conjunctival pigmented lesions, and the pathological examinations constantly showed melanoma . In the course, she showed gradual widening of pigmented lesions to upper bulbar conjunctiva and lower palpebral conjunctiva and lower eyelid. About 2.5 years from the initial visit, the lower eyelid lesion was resected for a genomic DNA-based test of mutations which turned out to be absent, and then, she began to have intravenous anti-programmed cell death-1 (PD-1), nivolumab every 3 or 4 weeks. She developed iritis in the right eye with conjunctival melanoma as an immune-related adverse event, 3 months after the beginning of nivolumab, and so she used daily topical 0.1% betamethasone eye drops to control the intraocular inflammation. She showed no metastasis in 6 years of follow-up, but later in the course, 5 years from the initial visit, she developed abruptly a non-pigmented nodular lesion on the temporal side of the bulbar conjunctiva along the corneal limbus, accompanied by two pigmented nodular lesions in the upper and lower eyelids in a few months. She thus, underwent proton beam therapy toward the conjunctival melanoma and achieved the successful local control. Proton beam therapy is a treatment option in place of orbital exenteration, and multidisciplinary team collaboration is desirable to achieve better cosmetic and functional outcomes in conjunctival malignant melanoma.
结膜恶性黑色素瘤极为罕见，目前尚无既定的标准治疗方案。在此，我们报告一名65岁女性，她是一名乙型肝炎病毒（HBV）携带者，同时出现肝脏肿块和右眼下方球结膜色素沉着病变。肝脏穿刺活检和结膜切除活检分别显示为肝细胞癌和结膜恶性黑色素瘤。优先对肝细胞癌进行经动脉化疗栓塞术后行肝段切除术。1年内，她接受了第二次和第三次球结膜色素沉着病变切除术，病理检查一直显示为黑色素瘤。在此过程中，她的色素沉着病变逐渐扩展至上球结膜、下睑结膜和下眼睑。初次就诊约2.5年后，切除下眼睑病变进行基于基因组DNA的突变检测，结果未发现突变，随后她开始每3或4周静脉注射抗程序性细胞死亡蛋白1（PD-1）药物纳武单抗。开始使用纳武单抗3个月后，她出现右眼虹膜炎，这是一种与免疫相关的不良事件，为结膜黑色素瘤所致，因此她每天使用0.1%倍他米松眼药水控制眼内炎症。随访6年未发现转移，但在初次就诊5年后的病程中，她突然在球结膜颞侧角膜缘处出现一个无色素结节性病变，几个月后上、下眼睑出现两个色素结节性病变。因此，她接受了针对结膜黑色素瘤的质子束治疗并成功实现局部控制。质子束治疗是一种可替代眼眶内容剜除术的治疗选择，多学科团队协作有助于在结膜恶性黑色素瘤治疗中获得更好的美容和功能效果。
