Abstract
Background
Growing evidence supports an individualised approach rather than radical surgery for conjunctival melanoma (CM). This study aimed to compare the long-term outcome between individualised and conventional exenteration techniques.
Methods
Our study retrospectively recruited advanced CM (clinical T3 stage) patients treated with individualised (13 cases) or conventional (18 cases) exenteration from June 2014 to April 2019. The individualised approach preserved at least three quadrants of the orbit, and the conventional procedures removed at least one third of the orbital tissues. The medical records were collected and analyzed during April 2020, including demographics, tumour characteristics, surgical details, postoperative rehabilitation and tumour-related prognosis.
Results
The tumour basal diameter was statistically (P = 0.011) larger in the conventional group (23.3 ± 7.6 mm) than in the individualised group (15.4 ± 6.3 mm). More tissues were preserved in the individualised group, resulting in a shorter duration of wound healing (2.1 ± 0.6 vs. 3.6 ± 2.0 weeks, P = 0.018) and less incidence of hollow appearance (15% vs. 72%, P = 0.003) than the conventional group. After follow-up for 39.3 ± 17.3 months, a comparison of survival curves showed no significant differences (P = 0.638) between the two groups. The 1- and 2-year overall survival rates were estimated as 100% and 80.0% in the individualised group, and 93.8% and 72.5% in the conventional group, respectively. Low or mixed pigmentation was identified as the risk factor for tumour-related mortality based on multivariate regression analysis.
Conclusions
The individualised approach to exenteration offers improved aesthetic results while still maximises the curable chance for advanced CM.
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Acknowledgements
The authors thank Dr. Rui Zhang (Fudan Eye & ENT Hospital) and Dr. Yifei Yuan (Fudan Eye & ENT Hospital) for providing medical records of patients treated with conventional exenteration.
Funding
This work was supported by the National Natural Science Foundation of China [grant number 82000940, 81970835 and 81800867].
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RM and HR conceived and designed the study. RM, HR and XZ reviewed the medical records. XZ, LG, BX and JG analysed the data. HR and JQ supervised the study. RM and HR wrote the paper. All authors revised the final version of the paper. JQ is the principal investigator of this work and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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Ma, R., Ren, H., Zhou, X. et al. Orbital exenteration for conjunctival melanoma: comparison of long-term outcome between individualised and conventional techniques. Eye 35, 3410–3418 (2021). https://doi.org/10.1038/s41433-021-01454-9
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DOI: https://doi.org/10.1038/s41433-021-01454-9
