Patterns of regional and distant metastasis in patients with conjunctival melanoma - Experience at a cancer center over four decades

Objective: The regional lymph nodes generally are believed to be the most c ommon first site of metastasis for conjunctival malignant melanoma, but the pattern of nodal metastasis in this disease has not been well established. The goal of this study was to determine the frequency, location, and timin g of regional lymph node metastasis in patients with conjunctival melanoma treated at one cancer center over four decades. Design: Retrospective case series. Participants: Twenty-seven patients. Methods: The clinical records of 27 patients with conjunctival malignant me lanoma were reviewed retrospectively. Main Outcome Measures: The rates of local conjunctival recurrence, regional nodal metastasis, and distant metastasis were analyzed along with overall survival. The follow-up time ranged from 2.5 to 17 years (median, 6 years). Results: Eleven patients (41%) experienced clinical regional lymph node met astasis 1.5 to 6.0 years (mean, 3.2 years) after the initial diagnosis. The involved lymphatics were the preauricular (parotid) nodes in 8 patients (7 3%), the submandibular nodes in 1 patient (9%), and the deeper cervical nod es in 2 patients (18%). In seven patients (26%), distant metastasis develop ed without evidence of prior or concurrent regional nodal disease. Patients in whom distant metastasis developed without clinical evidence of regional nodal involvement were more likely to have had local conjunctival recurren ce (P = 0.03) and a higher number of local recurrences (P = 0.05) compared with patients with regional lymph nodes as the site of first metastasis. Th e 5- and 10-year overall survival rates were 74% and 41%, respectively. Conclusions: Regional lymph node metastasis occurred in a higher percentage of patients with conjunctival malignant melanoma than has been reported pr eviously. Preauricular lymph nodes were most commonly involved. Distant met astasis without prior or concurrent lymph node involvement was not a rare e vent. Ophthalmology 2001;108:2101-2105 (C) 2001 by the American Academy of Ophthalmology.