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In primary conjunctival melanoma (CoM), one of the characteristics that is associated with an increased risk of metastases and death is a lack of tumour pigmentation. The aim of this study was to investigate whether the degree of pigmentation of CoM recurrences relates similarly to clinical outcome.
A data set of 177 patients with a CoM recurrence from the Wills Eye Hospital (USA) and the Leiden University Medical Center (The Netherlands) was analysed. The relation between clinical tumour pigmentation of the recurrences, the characteristics of the primary lesions and clinical outcome was investigated.
In 117 (66%) of 177 patients with a CoM recurrence, tumour pigmentation was known: 71 patients (61%) had recurrences with low pigmentation. Primary lesions had low pigmentation in 39% of cases, which is significantly different (p = 0.001). However, low tumour pigmentation of recurrences correlated with low tumour pigmentation of the primary lesion (p < 0.001). No association was observed between pigmentation of the recurrences and iris colour (p = 0.66). Low pigmentation of the recurrences was not significantly associated with an increased risk for metastases (HR 1.96, p = 0.12) or death (HR 1.79, p = 0.27), whereas primary tumours with low pigmentation did show a greater risk for metastases (HR 2.82, p = 0.016) and death (HR 2.90, p = 0.037).
CoM recurrences are more often lightly pigmented compared to primary lesions. A correlation exists between the degree of pigmentation of primary and recurrent lesions, but recurrences can appear with any degree of pigmentation. Unlike primary CoM, the level of pigmentation of CoM recurrences is not related to metastasis or death.
Tuomaala S, Eskelin S, Tarkkanen A, Kivela T (2002) Population-based assessment of clinical characteristics predicting outcome of conjunctival melanoma in whites. Invest Ophthalmol Vis Sci 43:3399–3408
Brouwer NJ, Marinkovic M, van Duinen SG, Bleeker JC, Jager MJ, Luyten GPM (2018) Treatment of conjunctival melanoma in a Dutch referral centre. Br J Ophthalmol 102:1277–1282. https://doi.org/10.1136/bjophthalmol-2017-311082 CrossRef
Shields CL (2000) Conjunctival melanoma: risk factors for recurrence, exenteration, metastasis, and death in 150 consecutive patients. Trans Am Ophthalmol Soc 98:471–492
Shields CL, Markowitz JS, Belinsky I, Schwartzstein H, George NS, Lally SE, Mashayekhi A, Shields JA (2011) Conjunctival melanoma: outcomes based on tumor origin in 382 consecutive cases. Ophthalmology 118:389–395 e381-382. https://doi.org/10.1016/j.ophtha.2010.06.021 CrossRef
Wong JR, Nanji AA, Galor A, Karp CL (2014) Management of conjunctival malignant melanoma: a review and update. Expert Rev Ophthalmol 9:185–204. https://doi.org/10.1586/17469899.2014.921119 CrossRef
Werschnik C, Lommatzsch PK (2002) Long-term follow-up of patients with conjunctival melanoma. Am J Clin Oncol 25:248–255 CrossRef
Brouwer NJ, Marinkovic M, Luyten GPM, Shields CL, Jager MJ (2019) Lack of tumour pigmentation in conjunctival melanoma is associated with light iris colour and worse prognosis. Br J Ophthalmol 103:332–337. https://doi.org/10.1136/bjophthalmol-2018-312018 CrossRef
Wakamatsu K, Hu DN, McCormick SA, Ito S (2008) Characterization of melanin in human iridal and choroidal melanocytes from eyes with various colored irides. Pigment Cell Melanoma Res 21:97–105. https://doi.org/10.1111/j.1755-148X.2007.00415.x CrossRef
Ito S, Wakamatsu K (2003) Quantitative analysis of eumelanin and pheomelanin in humans, mice, and other animals: a comparative review. Pigment Cell Res 16:523–531 CrossRef
Mitra D, Luo X, Morgan A, Wang J, Hoang MP, Lo J, Guerrero CR, Lennerz JK, Mihm MC, Wargo JA, Robinson KC, Devi SP, Vanover JC, D’Orazio JA, McMahon M, Bosenberg MW, Haigis KM, Haber DA, Wang Y, Fisher DE (2012) An ultraviolet-radiation-independent pathway to melanoma carcinogenesis in the red hair/fair skin background. Nature 491:449–453. https://doi.org/10.1038/nature11624 CrossRef
De Leeuw SM, Smit NP, Van Veldhoven M, Pennings EM, Pavel S, Simons JW, Schothorst AA (2001) Melanin content of cultured human melanocytes and UV-induced cytotoxicity. J Photochem Photobiol B 61:106–113 CrossRef
Larsen AC, Dahl C, Dahmcke CM, Lade-Keller J, Siersma VD, Toft PB, Coupland SE, Prause JU, Guldberg P, Heegaard S (2016) BRAF mutations in conjunctival melanoma: investigation of incidence, clinicopathological features, prognosis and paired premalignant lesions. Acta Ophthalmol 94:463–470. https://doi.org/10.1111/aos.13007 CrossRef
Scholz SL, Cosgarea I, Susskind D, Murali R, Moller I, Reis H, Leonardelli S, Schilling B, Schimming T, Hadaschik E, Franklin C, Paschen A, Sucker A, Steuhl KP, Schadendorf D, Westekemper H, Griewank KG (2018) NF1 mutations in conjunctival melanoma. Br J Cancer 118:1243–1247. https://doi.org/10.1038/s41416-018-0046-5 CrossRef
Beadling C, Jacobson-Dunlop E, Hodi FS, Le C, Warrick A, Patterson J, Town A, Harlow A, Cruz F 3rd, Azar S, Rubin BP, Muller S, West R, Heinrich MC, Corless CL (2008) KIT gene mutations and copy number in melanoma subtypes. Clin Cancer Res 14:6821–6828. https://doi.org/10.1158/1078-0432.CCR-08-0575 CrossRef
Griewank KG, Murali R, Schilling B, Scholz S, Sucker A, Song M, Susskind D, Grabellus F, Zimmer L, Hillen U, Steuhl KP, Schadendorf D, Westekemper H, Zeschnigk M (2013) TERT promoter mutations in ocular melanoma distinguish between conjunctival and uveal tumours. Br J Cancer 109:497–501. https://doi.org/10.1038/bjc.2013.312 CrossRef
Ossowski L, Aguirre-Ghiso JA (2010) Dormancy of metastatic melanoma. Pigment Cell Melanoma Res 23:41–56. https://doi.org/10.1111/j.1755-148X.2009.00647.x CrossRef
Paridaens AD, McCartney AC, Lavelle RJ, Hungerford JL (1992) Nasal and orbital recurrence of conjunctival melanoma 21 years after exenteration. Br J Ophthalmol 76:369–371 CrossRef
Brouwer NJ, Genders SW, Marinkovic M, van Duinen SG, Jager MJ, Luyten GPM (2018) Two late recurrences of conjunctival melanoma. Ocul Oncol Pathol. https://doi.org/10.1159/000494978
- Pigmentation of conjunctival melanoma recurrences and outcome
Niels J. Brouwer
Gregorius P. M. Luyten
Carol L. Shields
Martine J. Jager
- Springer Berlin Heidelberg
Graefe's Archive for Clinical and Experimental Ophthalmology
Incorporating German Journal of Ophthalmology
Print ISSN: 0721-832X
Elektronische ISSN: 1435-702X