Management of conjunctival and corneal melanoma with surgical excision, amniotic membrane allograft, and topical chemotherapy

PURPOSE: To illustrate a novel method of management for extensive conjuncti val and corneal melanoma METHODS: Interventional case report. A 40-year-old Caucasian woman presente d with a large, diffuse conjunctival melanoma involving 6 clock hours of th e limbus. The remaining bulbar conjunctiva and the entire corneal epitheliu m were affected by diffuse, flat melanosis. RESULTS: The conjunctival melanoma was completely resected microsurgically in one piece without disrupting the tumor. The conjunctival melanosis was t reated with double freeze-thaw cryotherapy. The extensive conjunctival defe ct, involving one half of the bulbar conjunctiva, was reconstructed with an amniotic membrane allograft. The corneal melanosis was subsequently treate d with topical mitomycin C eyedrops. At 8 months follow-up, the conjunctiva and the cornea were completely healed with resolution of all pigment and 2 0/20 visual acuity. CONCLUSION: Preliminary evidence suggests that combined therapeutic approac hes, consisting of extensive tumor removal, cryotherapy, amniotic membrane allot graft, and topical mitomyin C, can be effective in the management of diffuse conjunctival and corneal melanoma arising from primary acquired mel anosis. (C) 2001 by Elsevier Science Inc. All rights reserved.