Immediate and late treatment outcomes of radiation therapy plus cryosurgery for the treatment of conjunctival melanoma
DOI:
https://doi.org/10.31288/oftalmolzh202543034Keywords:
ocular oncology, conjunctival tumor, radiation therapy, cryodestruction, radiation therapy plus cryosurgery, conjunctivaAbstract
Purpose. To assess immediate and late treatment outcomes of radiation therapy (RT) plus cryosurgery for the treatment of conjunctival melanoma (CM).
Material and Methods: The study sample consisted of 88 patients who underwent RT plus cryosurgery for the treatment of CM at SI “The Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine” during 2004-2024. Of these CM patients, 45 (52.1%) were males (age range, 20 to 88 years; median, 54.1 years), and 43 (47.9%) were females (age range, 26 to 87 years; median, 56.6 years).
Results: After RT plus cryosurgery, complete tumor resorption was seen in 77 patients (87.5%), and partial tumor resorption in 11 patients (12.5%). At 3 to 6 months, additional cryodestruction was performed in 8 patients (9.1%) with partial tumor resorption, which resulted in complete tumor resorption. Therefore, local control was attained in 85 patients (96.6%) after RT plus cryosurgery. Tumor recurrence was observed in 12.5% of patients, appeared as a nodule within the site of the primary tumor, and was successfully cured with cryodestruction. After RT plus cryosurgery, patients were followed up for 1 to 7 years (median, 5.1 years). Regional lymph node metastasis developed after treatment for CM in 8 patients (9.1%). Two patients developed distant metastasis. One of them developed metastasis in the lung five years post-treatment and another in the brain three years post-treatment, and tumor resorption was observed at the initial site of CM in both patients. Persistent tumor ingrowth in the orbit necessitated orbital exenteration in 3 patients (3.4%) with iatrogenic tumor.
Conclusion: RT plus cryosurgery is an effective method of treatment for CM with an efficacy of treatment up to 96.6% and a recurrence rate of 12.5%. The method extends opportunities for organ-preserving treatment for CM and enables retreatment in case of tumor recurrence, with rather good functional and esthetic outcomes and improved patient’s quality of life.
References
Shields CL, Shields JA, Gunduz K, et al. Conjunctival melanoma: risk factors for recurrence, exenteration, metastasis, and death in 150 consecutive patients. Arch Ophthalmol. 2000; 118 (11): 1497-1507. https://doi.org/10.1001/archopht.118.11.1497
Damato B, Coupland SE. Conjunctival melanoma and melanosis: a reappraisal of terminology, classification and staging. Clin Experiment Ophthalmol. 2008; 36(8):786-95. https://doi.org/10.1111/j.1442-9071.2008.01888.x
Missotten GS, Keijser S, De Keizer RJ. et al. Conjunctival melanoma in the Netherlands: a nationwide study. Rouendaal Invest Ophthalmol. Vis Sci. 2005; 46 (1): 75-82. https://doi.org/10.1167/iovs.04-0344
Triay E, Bergman L, Nilsson B, All-Ericsson C, Seregard S. Time trends in the incidence of conjunctival melanoma in Sweden. Br J Ophthalmol. 2009; 93 (11): 1524-1528. https://doi.org/10.1136/bjo.2009.157933
Damato B, Coupland SE. An audit of conjunctival melanoma treatment in Liverpool. Eye (Lond). 2009;23 (4):801-809. https://doi.org/10.1038/eye.2008.154
Brownstein S. Malignant melanoma of the conjunctiva. Cancer Control 2004; 11 (5): 310-316. https://doi.org/10.1177/107327480401100505
Damato B, Coupland SE . Management of conjunctival melanoma. Expert Rev Anticancer Ther 2009; 9 (9): 1227-39. https://doi.org/10.1586/era.09.85
Kurli M, Finger PT . Melanocytic conjunctival tumors. Ophthalmol Clin North Am 2005; 18 (1): 15-24; https://doi.org/10.1016/j.ohc.2004.08.005
Missotten GS, Keijser S, De Keizer RJ, Wolff-Rouendaal DD. Conjunctival melanoma in the Netherlands: a nationwide study. Inves Ophthalmol Vis Sci. 2005; 46 (1): 75-82; https://doi.org/10.1167/iovs.04-0344
Shields JA, Shields CL, Gündüz K et al. Clinical features predictive of orbital exenteration for conjunctival melanoma. Ophthal Plast Reconstr Surg. 2000; 16 (3): 173-8. https://doi.org/10.1097/00002341-200005000-00003
Anastassiou G, Heiligenhaus A, Bechrakis N et al. Prognostic value of clinical and histopathological parameters in conjunctival melanomas: a retrospective study. Br J Ophthalmol. 2002; 86 (2): 163-7. https://doi.org/10.1136/bjo.86.2.163
Damato B, Coupland SE. Clinical mapping of conjunctival melanomas. Br J Ophthalmol. 2008; 92 (11): 1545-1549. https://doi.org/10.1136/bjo.2007.129882
Folberg R, McLean IW, Zimmerman LE. Conjunctival Melanosis and Melanoma. Ophthalmology. 1984; 91(6): 673-678. https://doi.org/10.1016/S0161-6420(84)34245-2
Rodemann HP. Molecular radiation biology: Perspectives for radiation oncology. Radiother Oncol. 2009 Sep;92(3):293-8.https://doi.org/10.1016/j.radonc.2009.08.023
Peksayar G, Soyturk MK, Demiryont M. Long-term results of cryotherapy on malignant epithelial tumors of the conjunctiva. Am J Ophthalmol. 1989; 107(4): 337-340. https://doi.org/10.1016/0002-9394(89)90655-7
Peksayar G, Altan-Yaycioglu R, Onal S. Excision and cryosurgery in the treatment of conjunctival malignant epithelial tumours. Eye. 2003;17(2): 228-32. https://doi.org/10.1038/sj.eye.6700331
Grimes JM, Shah NV, Samie FH, Carvajal RD, Marr BP. Conjunctival Melanoma: Current Treatments and Future Options. Am J Clin Dermatol. 2020;21:371-381. https://doi.org/10.1007/s40257-019-00500-3
Kenawy N, Lakе SL, Coupland SE. et al. Conjunctival melanoma and melanocytic intraepithelial neoplasia. Eye. 2013; 27(2):142-52. https://doi.org/10.1038/eye.2012.254
Finger PT. «Finger-tip» cryotherapy probes: treatment of squamous and melanocytic conjunctival neoplasia. Br J Ophthalmol. 2005; 89(8):942-945. https://doi.org/10.1136/bjo.2004.064204
Shields CL, Chien JL, Surakiatchanukul T. et al. Conjunctival Tumors: Review of Clinical Features, Risks, Biomarkers and Outcomes. Gass Lecture. Asia Pac J Ophthalmol. 2017; 6(2):109-120. https://doi.org/10.22608/APO.201710
Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007; 39: 175-191.https://doi.org/10.3758/BF03193146
Shields CL, Markowitz JS, Belinsky I, Schwartzstein H, George NS, Lally SE, Mashayekhi A, Shields JA. Conjunctival melanoma: Outcomes based on tumor origin in 382 consecutive cases. Ophthalmol. 2011;118(2): 389-395.e2. https://doi.org/10.1016/j.ophtha.2010.06.021
Shields JA, Shields CL, Mashayekhi A, Marr BP, Benavides R, Thangappan A, Phan L, Eagle RC. Primary acquired melanosis of the conjunctiva: Risks for progression to melanoma in 311 eyes. Ophthalmol. 2008;115:511-519. https://doi.org/10.1016/j.ophtha.2007.07.003
Brouwer NJ, Marinkovic M, van Duinen SG, Bleeker JC, Jager MJ, Luyten GPM. Treatment of conjunctival melanoma in a Dutch referral centre. Br J Ophthalmol. 2018;102:1277-1282. https://doi.org/10.1136/bjophthalmol-2017-311082
Wong JR, Nanji AA, Galor A, Karp CL. Management of conjunctival malignant melanoma: A review and update. Expert Rev Ophthalmol. 2014;9:185-204. https://doi.org/10.1586/17469899.2014.921119
Karam Butt, Rumana Hussain, Sarah E Coupland , Yamini Krishna Cjnjunctival melanoma: a clinical review and update. Cancers (Basel). 2024 Nov 5;16(22):3721. https://doi.org/10.3390/cancers16223721
Werschnik C, Lommatzsch PK. Long-term follow-up of patients with conjunctival melanoma. Am J Clin Oncol. 2002;25(3):248-255. https://doi.org/10.1097/00000421-200206000-00009
Yu G-P, Hu D-N, McCormick S, Finger PT. Conjunctival melanoma: is it increasing in the United States? Am J Ophthalmol. 2003;135(6):800-806. https://doi.org/10.1016/S0002-9394(02)02288-2
De Potter P, Shields CL, Shields JA, Menduke H. Clinical predictive factors for development of recurrence and metastasis in conjunctival melanoma: A review of 68 cases. Br J Ophthalmol. 1993;77:624-630. https://doi.org/10.1136/bjo.77.10.624
Tuomaala S, Kivelä T. Metastatic pattern and survival in disseminated conjunctival melanoma: implications for sentinel lymph node biopsy. Ophthalmol. 2003; 111 (4):816-821.https://doi.org/10.1016/j.ophtha.2003.11.001
Jain P, Finger PT. Conjunctival melanoma treatment outcomes in 288 patients: a multicentre international data-sharing study. 2020; 105 (10):1358-1364. https://doi.org/10.1136/bjophthalmol-2020-316293
Kenawy N, Lake SL, Coupland SE, Damato BE. Conjunctival melanoma and melanocytic intra-epithelial neoplasia. Eye (Lond). 2013; 27(2): 142-152. https://doi.org/10.1038/eye.2012.254
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Safronenkova I. O., Buiko O. S.
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) that allows users to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author as long as they cite the source.
COPYRIGHT NOTICE
Authors who publish in this journal agree to the following terms:
- Authors hold copyright immediately after publication of their works and retain publishing rights without any restrictions.
- The copyright commencement date complies the publication date of the issue, where the article is included in.
DEPOSIT POLICY
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) during the editorial process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work with an acknowledgement of its initial publication in this journal.
- Post-print (post-refereeing manuscript version) and publisher's PDF-version self-archiving is allowed.
- Archiving the pre-print (pre-refereeing manuscript version) not allowed.
