We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Observation |

Eye-Preserving Treatment for Invasive Conjunctival Melanoma

Alison M. Dzwonczyk, MD1; Zélia M. Corrêa, MD, PhD1,2; James J. Augsburger, MD1,2; Dwight Kulwin, MD2
[+] Author Affiliations
1University of Cincinnati College of Medicine, Cincinnati, Ohio
2Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio
JAMA Ophthalmol. 2014;132(12):1486-1488. doi:10.1001/jamaophthalmol.2014.2871.
Text Size: A A A
Published online


Although orbital exenteration has been recommended for extensive malignant conjunctival neoplasms, including those invading the palpebral margin, fornices, or caruncle, it has not been demonstrated to improve survival of patients with melanomas greater than 2.0 mm thick.1 We describe a patient with extensive conjunctival melanoma (CM) managed by eye-preserving therapies.

Article InformationCorresponding Author: Zélia M. Corrêa, MD, PhD, Department of Ophthalmology, University of Cincinnati College of Medicine, 260 Stetson St, Ste 5300, Cincinnati, OH 45267 (correazm@ucmail.uc.edu).

Published Online: August 28, 2014. doi:10.1001/jamaophthalmol.2014.2871.

Conflict of Interest Disclosures: None reported.

Funding/Support: This work was supported in part by an unrestricted grant from Research to Prevent Blindness (Dr Augsburger).

Role of the Funder/Sponsor: Research to Prevent Blindness had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Figure 1.
Initial Clinical Presentation and Histopathological Findings

A, Pigmented conjunctival mass in the left eye measuring 5.5 × 5 × 3 mm was visible superonasally when the patient looked left and down while retracting the upper eyelid. B, Intraoperative examination with eversion of the left upper eyelid revealed a more extensive nodular, darkly melanotic tumor arising from the forniceal conjunctiva superonasally and involving most of the forniceal and tarsal conjunctiva from the 10-o’clock to 2-o’clock meridians. C, Histopathological analysis revealed an invasive melanocytic tumor surrounded by a dense inflammatory infiltrate (hematoxylin-eosin, original magnification ×30). D, High-magnification photomicrograph revealed pronounced large, pleomorphic melanocytes with prominent nuclei, irregular chromatin, and well-defined nucleoli (hematoxylin-eosin, original magnification ×90).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Clinical Outcome

A, Three weeks following wider conjunctival excision, a symblepharon ring was fitted over the left ocular surface without difficulty. B, Three months after wide excision with amniotic membrane graft, the patient presented with a new amelanotic nodule located on the inferior temporal fornix in the left eye away from the initially resected tumor; it was found to be a conjunctival melanoma (epithelioid cell type). C, Ten days into the second cycle of treatment with topical mitomycin C, 0.02%, the patient presented with severe contact dermatitis and treatment was interrupted. D, At recent follow-up 15 months after wide excision of conjunctival melanoma and 5 months after completion of adjuvant topical chemotherapy, the patient has full ocular motility with minimal forniceal and conjunctival scarring.

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles

Care at the Close of Life: Evidence and Experience
The Role of Chemotherapy at the End of Life: "When Is Enough, Enough?"

Care at the Close of Life: Evidence and Experience
Chemotherapy and Hormonal Therapy