SURGICAL-MANAGEMENT OF CIRCUMSCRIBED CONJUNCTIVAL MELANOMAS

Circumscribed conjunctival melanoma usually arises in the bulbar conju nctiva and less often in the forniceal or palpebral conjunctiva. After simple superficial removal, employed by many ophthalmologists, these tumors have an increased tendency toward local recurrence and distant metastasis. A surgical procedure designed to remove the tumors complet ely and minimize the chances of recurrence would be desirable. The aut hors employed a surgical approach to conjunctival melanoma excision, w hich they believe insures more complete tumor removal and decreases th e chances of recurrence and metastasis. The surgical management of mel anoma in the limbal region of the bulbar conjunctiva consists of local ized alcohol epitheliectomy, removal of the mass by a partial lamellar scleroconjunctivectomy, and supplemental double freeze-thaw cryothera py to the adjacent remaining conjunctiva by a specific technique. For tumors located in the forniceal or palpebral conjunctiva, wide surgica l resection with alcohol treatment to the scleral base and cryotherapy to the surrounding conjunctiva is performed. A ''no touch'' technique is employed and direct manipulation of the tumor is strictly avoided in an effort to prevent tumor cell seeding into a new area. The techni que currently employed has evolved from experience with circumscribed conjunctival melanoma excision during a 20-year period. About 80 patie nts had circumscribed conjunctival melanoma unassociated with apprecia ble primary acquired melanosis. Although it is not the purpose of this article on surgical technique to provided a detailed statistical anal ysis of the results, the authors currently believe that this technique should be employed in all cases of circumscribed lesions in which con junctival melanoma is a diagnostic consideration. Incisional biopsy an d frozen sections are generally not advisable. Preliminary observation s suggest that this method decreases the chances of local recurrence.