Cryotherapy for precancerous melanosis (atypical melanocytic hyperplasia) of the conjunctiva
S. Brownstein, F. A. Jakobiec, R. D. Wilkinson, J. Lombardo and W. B. Jackson
Two patients with progressive, diffuse precancerous melanosis
(intraepithelial atypical melanocytic hyperplasia or melanocytic dysplasia)
of the conjunctiva were treated with cryotherapy. In one patient, the
contiguous cutaneous portions of both eyelids were involved and received
the same therapy; the extensive disease of the patient was managed by two
cryotherapy sessions during a period of 21/2 months. The melanocytic
process in both patients showed a good response to this therapy, which
resulted in a slough of the superficial conjunctiva with
reepithelialization from adjacent areas. Neither patients has shown
recurrent disease in more than seven months of follow-up, although one
patient had incomplete regression of the melanocytic condition in the
perilimbal region, which was subsequently treated by an excisional biopsy.
Serious complications occurred in one patient who had corneal and
lenticular opacities; this patient had severe extensive disease for which
exenteration was considered the only feasible alternative therapy to
control the melanocytic proliferation disorder adequately. Less severe
complications also developed, including trichiasis, ptosis, transient
hypotony, and macular edema. In this article, we discuss the clinical and
histologic features of acquired pigmentations of the conjunctiva, the
criteria for their management, and the approaches to minimize the
complications that we have encountered with cryotherapy.
