COMBINED SURGICAL EXCISION, CRYOTHERAPY A ND RADIOTHERAPY IN MALIGNANT MELANOMAS OF THE CONJUNCTIVA

Background Conjunctival melanomas are malginant tumors with a high loc al recurrence rate after simple surgical excision. The rate of recurre nce is particularly high in cases of large size tumor, of widespread t umors and with PAM associated lesions. Tumor recurrences have a bad lo ng-term prognostic significance and often necessitate exenteration. Pa tients and methods A method of therapy combining total surgical excisi on with proton-beam irradiation, cobalt plaque irradiation and cryothe rapy is described. This technique is used in particular unfavorable ca ses with the aim of lowering the rate of recurrences. It was practiced in 19 cases in Lausanne, 10 of which were recurrent tumors. The melan oma invaded 3 quadrants of the bulbar conjunctiva in 8 cases and 4 qua drants in 11 cases. At least one neighbouring tarsal conjunctiva was i nvaded in 11 cases and both in 7 cases. The skin of the eyelid was inf iltrated in 6 cases and the caruncle in 9 cases. Tumor thickness was 1 to 2 mm in 8 cases, 3 to 4 mm in 4 cases and 5 to 10 mm in 7 cases. R esults PAM was present in 16 cases. Follow-up period was less than 1 y ear in 2 cases, between 1 to 2 years in 5 cases, between 2 to 3 years in 5 cases and more than 3 years in 7 cases. 5 patients had lymphnode metastases, 3 died of metastatic disease and 2 had a local recurrence. One of these recurrences was small-sized and was excised, the other w as widespread and the patient died soon with metastatic disease. No ex enteration was performed. Conclusion The method of therapy that is her e described appears to be a valuable alternative to exenteration of th e orbit for the treatment of diffuse or large-size conjunctival melano mas which have a high risk of local recurrence.