Abstract
Purpose
To investigate clinical features and outcomes of conjunctival melanoma classified by tumour origin.
Methods
Retrospective review of conjunctival melanoma patients at a single ocular oncology centre between April 18, 1974 and September 9, 2019. Lesions were divided into three tumour origin groups (primary acquired melanosis [PAM], nevus, and de novo) and clinical features and outcomes were compared.
Results
There were 629 patients with conjunctival melanoma that arose from PAM (n = 476, 76%), nevus (n = 59, 9%), or de novo (n = 94, 15%). A comparison (PAM vs. nevus vs. de novo) revealed patients with tumours arising from PAM presented with older mean age (62 vs. 52 vs. 55 years, p < 0.001), worse initial logMAR visual acuity (Snellen equivalent 20/30 vs. 20/25 vs. 20/25, p = 0.03), and greater clock hour involvement (4.8 vs. 4.0 vs. 3.2, p < 0.001). Tumours arising from nevus had lower frequency of fornix (31% vs. 9% vs. 24%, p = 0.02) and tarsal involvement (29% vs. 9% vs. 26%, p = 0.046) and more frequent classification as AJCC category T1 (60% vs. 89% vs. 62%, p = 0.01). After follow-up of (57.2 vs. 68.2 vs. 51.7 months, p = 0.35), tumours arising from PAM had worse mean final visual acuity (20/50 vs. 20/40 vs. 20/40, p = 0.02) and greater frequency of visual acuity loss ≥3 lines (25% vs. 15% vs. 10%, p = 0.02). Kaplan–Meier estimates for 5-year risk showed no difference by tumour origin for visual acuity loss ≥3 lines, local tumour recurrence, exenteration, metastasis, or death.
Conclusions
Conjunctival melanoma most often arose from PAM, and tumour origin did not affect clinical outcomes.
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Funding
Support provided by the Eye Tumour Research Foundation, Philadelphia, PA (CLS, JAS). The funders had no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, or in the preparation, review or approval of the manuscript. Carol Shields, M.D. has had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. No conflicting relationship exists for any author.
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CLS was responsible for conception of the work. RRP, AY, LAD, SV, ALP, and CLS partook in the design of the work. RRP, AY, SV, ALP were responsible for data collection. RRP, AY, SV, ALP were responsible for data analysis and interpretation. RRP, AY, SV, ALP drafted the original article. LAD, SEL, JAS, and CLS were responsible for subsequent critical revisions of the article. RRP, AY, LAD, SV, ALP, SEL, JAS, and CLS all approved the final version to be published.
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Pacheco, R.R., Yaghy, A., Dalvin, L.A. et al. Conjunctival melanoma: outcomes based on tumour origin in 629 patients at a single ocular oncology centre. Eye 36, 603–611 (2022). https://doi.org/10.1038/s41433-021-01508-y
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DOI: https://doi.org/10.1038/s41433-021-01508-y
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