Conjunctival melanoma (CM) is a rare but potentially aggressive malignancy of the ocular surface with high rates of local recurrence and metastasis. Eighty-one consecutive patients with invasive conjunctival melanoma treated by the senior author over the course of 23 years were included in this study which aimed to evaluate the diagnostic yield from metastatic work-up tests for these patients. All imaging studies at baseline and during the follow-up were reviewed. The authors also reviewed the yield of sentinel lymph node biopsy (SLNB) in patients who had this procedure as part of their baseline staging. An overall nodal metastatic rate of 16% and distant metastatic rate of 26% was reported. The SLNB positivity rate was 23.1% (6 out of 26 patients). Eight out of 81 (10%) patients with CM had brain metastasis identified on routine brain magnetic resonance imaging. More than a third of patients with nodal metastasis and most patients with distant metastasis, including 100% of patients with brain metastasis, were detected to have metastatic disease during the follow-up period. The authors highlight the importance of continued long-term surveillance imaging. It should also be noted that 12 of 20 patients with distant metastasis (57%) never had nodal metastasis, highlighting the importance of continued surveillance for distant metastasis even with a negative SLNB result in this rare but potentially life-threatening disease.
Diagnostic yield of routine metastatic work-up in conjunctival melanoma
Reviewed by Su Young
Diagnostic yield of routine metastatic work-up in conjunctival melanoma.
CONTRIBUTOR
Su Young
Tennent Institute of Ophthalmology, NHS Greater Glasgow and Clyde, UK.
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