Shields J A, Shields C L, De Potter P
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, PA 19107, USA.
Ophthalmic Plast Reconstr Surg. 1998 May;14(3):208-15. doi: 10.1097/00002341-199805000-00012.
Circumscribed conjunctival melanoma usually arises in the bulbar conjunctiva and less often in the forniceal or palpebral conjunctiva. After simple superficial removal, employed by many ophthalmologists, these tumors have an increased tendency toward local recurrence and distant metastasis. A surgical procedure designed to remove the tumors completely and minimize the changes of recurrence would be desirable. The authors employed a surgical approach to conjunctival melanoma excision, which they believe insures more complete tumor removal and decreases the chances of recurrence and metastasis. The surgical management of melanoma in the limbal region of the bulbar conjunctiva consists of localized alcohol epitheliectomy, removal of the mass by a partial lamellar scleroconjunctivectomy, and supplemental double freeze-thaw cryotherapy to the adjacent remaining conjunctiva by a specific technique. For tumors located in the forniceal or palpebral conjunctiva, wide surgical resection with alcohol treatment to the scleral base and cryotherapy to the surrounding conjunctiva is performed. A "no touch" technique is employed and direct manipulation of the tumor is strictly avoided in an effort to prevent tumor cell seeding into a new area. The technique currently employed has evolved from experience with circumscribed conjunctival melanoma excision during a 20-year period. About 80 patients had circumscribed conjunctival melanoma unassociated with appreciable primary acquired melanosis. Although it is not the purpose of this article on surgical technique to provided a detailed statistical analysis of the results, the authors currently believe that this technique should be employed in all cases of circumscribed lesions in which conjunctival melanoma is a diagnostic consideration. Incisional biopsy and frozen sections are generally not advisable. Preliminary observations suggest that this method decreases the chances of local recurrence.
局限性结膜黑色素瘤通常发生于球结膜，较少见于穹窿部或睑结膜。许多眼科医生采用简单的浅表切除术后，这些肿瘤局部复发和远处转移的倾向增加。因此，需要一种旨在完全切除肿瘤并尽量减少复发几率的手术方法。作者采用了一种结膜黑色素瘤切除术的手术方法，他们认为这种方法能确保更彻底地切除肿瘤，并降低复发和转移的几率。球结膜角膜缘区黑色素瘤的手术治疗包括局部酒精上皮切除术、部分板层巩膜结膜切除术切除肿物，以及通过特定技术对相邻剩余结膜进行补充性双冻融冷冻疗法。对于位于穹窿部或睑结膜的肿瘤，则进行广泛的手术切除，对巩膜基底进行酒精治疗，并对周围结膜进行冷冻疗法。采用“无接触”技术，严格避免直接操作肿瘤，以防止肿瘤细胞播散到新的区域。目前采用的技术是在20年期间对局限性结膜黑色素瘤切除的经验基础上发展而来的。约80例患者患有与明显原发性后天性黑素沉着无关的局限性结膜黑色素瘤。虽然本文关于手术技术的目的不是对结果进行详细的统计分析，但作者目前认为，在所有诊断考虑为结膜黑色素瘤的局限性病变病例中均应采用该技术。一般不建议进行切开活检和冰冻切片检查。初步观察表明，这种方法可降低局部复发的几率。
