Combined surgery and cryotherapy for diffuse malignant melanoma of the conjunctiva
F. A. Jakobiec, S. Brownstein, R. D. Wilkinson, M. Khalil, W. C. Cooper and H. R. Shibata
Two patients who had refused exenteration for widespread conjunctival
melanoma were treated by a combination of cryotherapy and surgical
excisions. Cryotherapy was delivered only to the extensive areas of flat
intraepithelial melanocytic proliferation (precancerous melanosis), while
the surgical excisions were performed on the focal nodules, representing
localized invasive melanoma. In our two patients, the invasive nodules
measured, respectively, 1.2 and 1.5 mm in greatest thickness, placing them
in a low to borderline risk group for metastasis. Repeated cryoapplicatons
were required to control the widespread flat intraepithelial disease. The
conjunctiva tolerated these procedures well because the substantia propria
is not sacrificed as it must be in surgical conjunctivectomy, allowing
comparatively normal reepithelialization to occur from adjacent zones,
after the treated epithelium containing the melanocytes sloughs. No
evidence of invasive melanoma (cancerous melanosis) has developed in any of
the cryotreated areas of intraepithelial disease (precancerous melanosis);
sequential biopsies have established that the atypical melanocytes have
disappeared from the epithelium.
