The
n e w e ng l a n d j o u r na l
of
m e dic i n e
Images in Clinical Medicine Lindsey R. Baden, M.D., Editor
Conjunctival Melanoma
Colin W. McInnes, M.D. Lorne Bellan, M.D. University of Manitoba Winnipeg, MB, Canada lbellan@misericordia.mb.ca
A
78-year-old woman with a medical history of glaucoma, diabetes, and cataracts presented for a routine ophthalmologic visit, during which she was found to have an erythematous and brown maculopapular lesion in her right eye. She reported that the lesion had been present for approximately 1 year, during which time it had fluctuated in size and bled occasionally, but that it had not been associated with pain, pruritus, or visual changes. An excisional scleral keratectomy was performed, followed by cryotherapy and alcohol application. Histopathological analysis revealed malignant conjunctival melanoma associated with primary acquired melanosis with atypia, measuring 1.0 mm thick and 4.0 mm in diameter. Conjunctival melanoma can arise from primary acquired melanosis. It is often associated with regional metastases, and local recurrence after treatment is common. Adjuvant treatment in this patient included chemotherapy and topical mitomycin. Nodal examination, bone scan, and computed tomography of the head, neck, chest, and abdomen revealed no metastatic disease. Eighteen months after treatment, there was no evidence of recurrence.
DOI: 10.1056/NEJMicm1405612 Copyright © 2015 Massachusetts Medical Society.
1844
n engl j med 372;19 nejm.org May 7, 2015
The New England Journal of Medicine Downloaded from nejm.org at NYU WASHINGTON SQUARE CAMPUS on May 20, 2015. For personal use only. No other uses without permission. Copyright © 2015 Massachusetts Medical Society. All rights reserved.
n e w e ng l a n d j o u r na l
of
m e dic i n e
Images in Clinical Medicine Lindsey R. Baden, M.D., Editor
Conjunctival Melanoma
Colin W. McInnes, M.D. Lorne Bellan, M.D. University of Manitoba Winnipeg, MB, Canada lbellan@misericordia.mb.ca
A
78-year-old woman with a medical history of glaucoma, diabetes, and cataracts presented for a routine ophthalmologic visit, during which she was found to have an erythematous and brown maculopapular lesion in her right eye. She reported that the lesion had been present for approximately 1 year, during which time it had fluctuated in size and bled occasionally, but that it had not been associated with pain, pruritus, or visual changes. An excisional scleral keratectomy was performed, followed by cryotherapy and alcohol application. Histopathological analysis revealed malignant conjunctival melanoma associated with primary acquired melanosis with atypia, measuring 1.0 mm thick and 4.0 mm in diameter. Conjunctival melanoma can arise from primary acquired melanosis. It is often associated with regional metastases, and local recurrence after treatment is common. Adjuvant treatment in this patient included chemotherapy and topical mitomycin. Nodal examination, bone scan, and computed tomography of the head, neck, chest, and abdomen revealed no metastatic disease. Eighteen months after treatment, there was no evidence of recurrence.
DOI: 10.1056/NEJMicm1405612 Copyright © 2015 Massachusetts Medical Society.
1844
n engl j med 372;19 nejm.org May 7, 2015
The New England Journal of Medicine Downloaded from nejm.org at NYU WASHINGTON SQUARE CAMPUS on May 20, 2015. For personal use only. No other uses without permission. Copyright © 2015 Massachusetts Medical Society. All rights reserved.
