Search

Squamous cell carcinoma is the most common malignant tumor of the bulbar conjunctiva. However, it often remains under-diagnosed and exposed to therapeutic delay. The aim of this work is to elucidate the diagnostic and therapeutic difficulties posed by this tumor and to appreciate its prognosis., (Copyright © 2019. Published by Elsevier Masson SAS.)

Conjunctival-pigmented tumors are rare, but they are one of the most commonly encountered by the pathologist working with the department of ophthalmology. Nevus and melanoma can be encountered and have some histological difference compared to their cutaneous counterpart. Primary acquired melanosis (PAM) is a conjunctival specific entity. This clinical term includes several histological lesions ranging from benignity to melanoma precursor lesion. Histologic examination determines the therapy and the risk of progression to melanoma. We present here a histopathological, clinical and therapeutic synthesis of conjunctival-pigmented lesions, emphasizing the importance of a good understanding between clinicians and pathologists., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Purpose: To discuss possible factors that could influence the prognosis of primary malignant conjunctival tumors., Patients and Methods: We retrospectively analyzed medical records of 79 patients followed for primary malignant conjunctival tumors between January 1997 and July 2011., Results: The mean age at the time of diagnosis was 61.1 years; male/female ratio was 2.59. The mean tumor size was 13.9 mm. The histological type was invasive squamous cell carcinoma in 43 cases (54.4%), epithelial dysplasia in 11 cases (13.9%), carcinoma in situ in 7 cases, conjunctival malignant melanoma in 5 cases, conjunctival lymphoma in 4 cases and other rare tumors in 9 cases. We performed an excisional biopsy with a safety margin in 89.8% of cases, associated with cryotherapy in 46.6% of cases. Enucleation was performed in two cases and orbital exenteration in 5 cases. We noted tumor recurrence in 33.3% of patients after an average period of 9.5 months. Radiation therapy was indicated in 44 cases (55.7%). The mean follow-up of our patients was 42 months. Tumor recurrences were statistically associated with a history of xeroderma pigmentosum (P=0.012), a diagnostic delay more than 11 months (P=0.001), caruncular location (P=0.004), tumor size greater than 10mm (P=0.044), scleral extension (P=0.011), initial treatment limited to excisional biopsy (P=0.033) and histopathologic involvement of the margin of the tumor resection (P=0.008)., Conclusion: A better understanding of the prognostic factors of primary malignant conjunctival tumors is essential for management and may improve the prognosis of these tumors., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

The main conjunctival tumors are represented by (i) conjunctival melanoma, ocular surface squamous neoplasia, and conjunctival lymphoma, which are malignant tumors, and (ii) conjunctival nevus, papilloma, and choristoma, which are benign. In usual practice, ophthalmologists need to know how to differentiate conjunctival melanomas and carcinomas from the other conjunctival tumors by clinical examination. Indeed, the therapeutic approach to these two malignant diseases presents a number of particularities such as the need for surgery under general anesthesia, if possible, to minimize the risk of local dissemination and further local recurrence, and detailed information on the tumor location and measurements before surgery (Figures, diagram, sizes) to precisely define the irradiation field during complementary radiotherapy. The clinical signs and main therapeutic principles of conjunctival tumors are reviewed in this article., (Copyright (c) 2010 Elsevier Masson SAS. All rights reserved.)

We report four cases referred to the Ophthalmologic Department of the University Hospital Center of Fort de France for the therapeutic management of a conjunctival malignant tumor. All cases reported involved conjunctival squamous cell carcinoma. All tumors were unilateral, one was localized, another was recurrent, one occurred in a patient with acquired immunodeficiency syndrome, and the last one was seen at the late stage of massive locoregional invasion. Three patients had surgery completed by corneolimbic cryotherapy. The last case was exentered. All of them consulted regularly. These four cases were collected over 5 years in approximately 15,000 patients examined per year in the University Hospital Center of Fort de France. Conjunctival squamous cell carcinoma is rare, even in Martinique, a tropical area. Careful attention to risk factors such as the sun exposure is recommended, as is the histologic diagnosis with any conjunctival tumour, since it changes quickly. The treatment must be adapted to the extension of the disease and to the patient's general health. The high rate of recurrence requires long-term follow-up in corneal and conjunctival intraepithelial neoplasia.

We describe the clinical and histopathological findings of a conjunctival squamous cell carcinoma occurring in a patient with acquired immunodeficiency syndrome (AIDS). The excisional biopsy specimen disclosed a papillar, well differentiated and mature squamous cell carcinoma with microinvasion. The biopsy was studied for the presence of Human papilloma virus DNA by using in situ hybridization but no signal was demonstrated in any part of the tumour. Although Kaposi's sarcoma and non-Hodgkin's lymphomas are the most common malignancies reported in AIDS, squamous cell carcinomas may be encountered in the disease. Underlying infection with the human immunodeficiency virus should be considered when conjunctival localization of such malignancies is observed.

A 92 year old woman was noted to have three black conjunctival nodules and a black-brown pigmentation of the temporal conjunctiva. Extensive diffuse intraepithelial conjunctival melanomar was developed with invasive nodules. We treated this disease by judicious excision of the invasive nodules combined with cryotherapy delivered to the surrounding flat intraepithelial areas of involvement.

A retrospective study of 40 melanocytic conjunctival tumors (22 naevi and 18 malignant melanoma) is reported. Cases of non-degenerated conjunctival melanosis were not observed. The particular aspects of diagnosis and the prognostic behaviour of these proliferations are discussed and compared with their cutaneous homologues. Epithelial inclusions within tumor cell proliferation are considered as the best criterion of benignity. Because conjunctival melanomas are rather uncommon and technical difficulties in their study are very frequent (poor quality of tissue samples, small size of specimens) many reports are contradictory. Some diagnostic signs are specific for this kind of tumor in the conjunctiva: nevertheless, the particular conjunctival anatomy makes it impossible to classify according to criteria defined for cutaneous malignant melanoma. No criteria would have a predictive value. The severe prognosis of conjunctival melanoma (44% deaths in the present series over 10 years after diagnosis) has been underestimated. Most often carcinologic therapies have not been used in previously reported cases.

Long-term prognosis was analyzed by a retrospective study of 56 patients with malignant melanoma of the conjunctiva and the eyelids. Survival rate at 5 years was 85 p. cent, at 10 years 68 p. cent, and at 15 or 20 years 55 p. cent; neither the localization of the tumor nor the type of initial treatment had a significant influence on these rates. Local or nodal recurrences occurred in 80 p. cent of cases, and were frequent following conservative surgery; prognosis is bad after radiotherapy.

A 68-year-old white female with lentigo malignans of the right conjunctiva and lid developed recurrent malignant melanomas of the conjunctiva 16 years after, lesions were treated by local excision and cryotherapy on several occasions. The prognosis of the three different histologic types of malignant melanoma described by Clark: nodular melanoma, superficial spreading melanoma, and lentigo malignans melanoma is discussed. Histologic features associated with the height of the tumor are important factors for prognosis, patients with lentigo malignans melanoma appearing to have a better systemic prognosis than those with superficial spreading or nodular melanoma. Possible therapeutic approaches to this condition are exenteration of the orbit, excision combined with cryotherapy, and excision combined with radiotherapy. The advantages of each of these treatments, and their indications, are discussed.