Conjunctival melanoma: pitfalls and dilemmas in management

The current dilemmas in the diagnosis and management of conjunctival melanoma are reviewed in this paper. Available evidence for the role of sentinel lymph node biopsy as it applies to conjunctival melanoma is examined.

The incidence of conjunctival melanoma appears to be on the rise. Analyses of 770 patients with conjunctival melanoma reveals a nearly 50% rate of local recurrence, and up to a 38% 10-year mortality. Adverse outcomes can be minimized by adjuvant therapies and 'no touch' techniques at the time of initial surgery. The metastatic spread occurs via both lymphatic channels and hematogenously. Sentinel lymph node biopsy does not appear to have a significant impact on survival or subsequent treatment.

The management of conjunctival surface melanomas is complicated by local recurrence and metastatic disease, particularly for lesions greater than 2 mm in thickness and arising from nonbulbar conjunctiva. Early complete excision with appropriate adjuvant cryotherapy and topical chemotherapy may be curative in some patients. Conjunctival anatomy and high recurrence rate with resultant metastatic spread undermines the utility of sentinel lymph node biopsy in this condition. Further research and innovation for detection of systemic micrometastases and treatment of metastatic disease are needed.