First Author: A.Arora UK
Co Author(s): V. Cohen J. Hungerford 0 0 0 0 0 0 0 0 0
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We present a case of a patient who was originally and successfully treated for a choroidal melanoma but now presents with an ipsilateral conjunctival melanoma with Primary Acquired Melanosis 17 years later.
Department of Ocular Oncology, St. Bartholomew's Hospital, London, UK
We report a case of a 64 year old Caucasian male who was first treated with proton beam radiotherapy for a choroidal melanoma at the posterior pole of his right eye in January 1995, which has shown an excellent and sustained response for many years. He presented with a gelatinous, mobile conjunctival mass lesion on the temporal, perilimbal bulbar surface in December 2012. Subsequent excision biopsy of the lesion found it to be a conjunctival melanoma in a background of primary acquired melanosis with severe atypia. There is no other evidence of conjunctival melanosis elsewhere.
Primary acquired melanosis is the most important, potentially premalignant, lesion with a risk for progression to conjunctival melanoma. It typically presents in middle-aged or elderly Caucasian patients with areas of unilateral flat, and variably pigmented lesions. Histologically, the intraepithelial component of the tumour extended into the surrounding ‘normal’ tissue making it highly likely that this was a separate primary conjunctival tumour and not related to the original choroidal melanoma. Although both conjunctival and uveal melanoma arise from the same melanocytic cells, it is exceptionally rare for both diseases to present in the same eye of an individual. Although a case report exists of multiple conjunctival metastasis to an eye previously treated for a uveal melanoma, the time differential in presentation of 18 years would suggest separate diseases. This may represent the first reported case.