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Conservative resection and adjuvant plaque brachytherapy for early stage conjunctival melanoma Li-Anne Lim The University of Sydney, Sydney NSW Australia, Sydney Eye Hospital Australia, Purpose: To evaluate the outcome for early stage bulbar conjunctival melanoma (CM) lesions treated with conservative resection and adjuvant Iodine-125 plaque brachytherapy. Methods: Nineteen consecutive patients with primary (n=3) or recurrent (n=16) early stage bulbar CM were reviewed. Early stage disease was defined as histopathological evidence of atypical melanocytic cells replacing greater than 75% of the normal thickness (melanoma-in-situ) or invading the substantia propria not more than 1.5mm thick. Following pre-operative staging of disease extent, all patients underwent conservative local excision, adjuvant Iodine-125 plaque brachytherapy administered within one month of excision. Results: Clinically all tumours were staged as T1a N0 M0. Median tumour maximal diameter was 7.1 mm (range: 4 - 11 mm) and median thickness was 0.7mm (range 0.2-1.6mm). Mean age was 55.2 years (range: 36-72 years), male: female (8:11). and mean follow up was 40.1 months (range: 30.1-54.3 months). Good local control was achieved with no local recurrences observed. Three patients developed new primary acquired melanosis with atypia lesions, distant from the surgical site and irradiation field. No clinically evident loco-regional spread or distant metastatic disease was observed. Median visual acuity and intraocular pressure were unchanged at three months follow up. Six patients developed transient corneal ulceration in the acute postoperative period that was managed successfully with a bandage contact lens. No intraocular or sight-threatening complications were observed and all patients survived. Conclusion: Conservative resection and adjuvant plaque brachytherapy achieved good local tumour control for CM, with little ocular morbidity. |
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