Melanoma and PAM with Atypia

Description
Malignant melanoma can occur on the surface of the eye (conjunctiva and cornea). It can start on its own, as a pre-existing nevus or arise within newly formed pigmentation called primary acquired melanosis (PAM).

Primary acquired melanosis with atypia (biopsy proven).

Symptoms
Most patients notice either a nodule forming on, or a darkening of the surface of the eye. Rarely large tumors can bleed resulting in "bloody tears." The tumor can extend onto the eyelid skin and lymph nodes in front of the ear (preauricular) or neck (cervical). Involved lymph nodes enlarge and can be felt (palpable) during examination.

Diagnosis
The doctor will examine your eyes. This includes an examination of all the conjunctival surfaces (including the inside of the eyelids). Pigmented conjunctival tumors are considered suspicious if they have large blood vessels running toward them, if they extend onto the cornea or if they extend into the conjunctival fornices.

Digital photographs are usually taken of all the conjunctival surfaces at the time of initial examination. This both helps the doctor document the extent of the condition at the time of the exam and can be used to plan for surgery.

A simple biopsy can determine whether a pigmented conjunctival tumor is a nevus, primary acquired melanosis, or conjunctival melanoma. A conjunctival nevus and primary acquired melanosis without atypia can be photographed and followed for evidence of change. Malignant conjunctival melanoma and primary acquired melanosis with atypia should be removed or destroyed.

Treatments
Most small conjunctival tumors can be photographed and followed for evidence of growth prior to treatment. If they are raised, hypervascular or extend onto the cornea a biopsy is reasonable. Small tumors can be completely removed, and if they are found to be either squamous carcinomas or melanomas additional cryotherapy (freezing) may be necessary. Dr. Finger has developed specialized "Finger-tip" cryotherapy probes that more uniformly freeze the surface of the eye.

Melanomas can be difficult to treat if they occur at multiple spots on the eye. In these cases, surgical removal with freezing therapy may not control this tumor. Several groups of ophthalmic oncologists are currently investigating the use of chemotherapy eye-drops for patients with conjunctival melanoma. This treatment treats the entire surface of the eye, and is less dependent upon defining the tumors edges.

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