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What is the cause and treatment for conjunctival malignant melanoma?

Q: My sister is 28 years old. She has a small spot in her right eye from a long time. It is increasing now and we were advised to take exision and biopsy of the spot. Operation for exision has been done and the eye sight is OK. But the biopsy report is: The section shows atypical melanocities diffusely infiltrating the deeper structure with production of melanin pigment. The tumour shows both radial as well as vertical growth pattern & tumour cells are infiltrating the superficial epithelial lining. Although the lateral margins appear free from tumour, the deeper line of resection show presence of atypical cells. We took a second opinion from another doctor who opined: Section shows a lesion composed of nests of polygonal cells with hyperchromatic nuclei. The nests of cells are surrounded by fibrous septa. Some of the tumour cells contain melanin pigment. Tumour cells have infiltrated the overlying stratified squamous epithelium. Junctional activity is seen. Impression - malignant melanoma, conjunctiva. What should we do now?

A:Melanoma is a type of cancer that originates within the cells (called melanocytes) that form the pigment melanin. These cells can be found throughout the body. While melanoma is most commonly found on the skin, it can also occur inside the eye as well as on the surface. The pigmented areas of eye such as the choroid and iris are most commonly affected; however, melanoma sometimes occurs on the conjunctiva, the eyes outermost covering as well. Conjunctival malignant melanoma is rare malignancy and most arise from a condition called primary acquired melanosis (pigmentation). The malignancy may also arise from a freckle or nevus on the conjunctiva, or even healthy tissue. A definitive diagnosis can only be made after surgical excision of suspicious lesions. Good vision in the affected eye is often preserved. Conjunctival malignant melanoma may metastasize to the another area of the body. If this occurs, the patients survival depends on the origin of the tumour, i.e. whether the tumour arose from primary acquired melanosis, a conjunctival nevus, or healthy tissue. In many cases, this cannot be determined. The prognosis is often good but those diagnosed with conjunctival melanoma must have a systemic evaluation and routine follow-up evaluations. The treatment of conjunctival melanoma is surgical, with complete removal of the tumour, if possible The melanoma is usually removed using a no-touch technique, followed by freezing (cryotherapy) of the surgical margins. Tumour thickness, mixed cell type, and lymphatic invasion on histologic examination affect prognosis. In several studies, the 5-year survival rate after surgery and/or radiotherapy was 83-84%, and the 10-year survival rate was 69-80%. The 5-year recurrence rate in both studies was 39%. You need to consult an ophthalmologist and an oncologist so that appropriate treatment is planned.

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