Malignant tumors of the conjunctiva and cornea

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Squamous cell carcinoma of the conjunctiva and cornea

Squamous cell carcinoma of the conjunctiva and cornea is rare. Provoking factors include ultraviolet radiation, human papillomavirus and HIV infection. Most often, the tumor is diagnosed in people over 50 years of age. It can be located in any part of the conjunctiva. The first signs of the disease are local hyperemia and thickening of the conjunctiva. The tumor can look like a papillomatous whitish-pink node and even a whitish pterygium in combination with elements of inflammation. Its borders are unclear, on the surface in the tumor papillae, chaotically located delicate proper vessels are clearly visible. The tumor is characterized by fairly slow growth. Its aggressiveness is due to invasion into deeper tissues, destruction of the cornea, sclera and growth of tumor masses into the eye cavity. The choice of treatment method is determined by the location and size of the tumor. In case of small tumors located on the limbus and cornea, a pronounced effect is achieved by installing mitomycin C according to a special scheme for 2 weeks. A combination of local excision of the tumor with cryodestruction is possible. In case of tumor localization outside the limbus and cornea, brachytherapy is indicated in combination with local laser coagulation or electroexcision, or wide excision with simultaneous cryoapplications on the wound surface.

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Conjunctival melanoma

Conjunctival melanoma accounts for about 2% of all malignant tumors of the conjunctiva; it is most often diagnosed in the fifth or sixth decade of life, more often in men. The tumor develops from primary acquired melanosis (75%) and pre-existing nevi (20%) or is primary (5%). Melanoma can be localized in any part of the conjunctiva, but most often (up to 70%) - on the conjunctiva of the eyeball. The tumor can be pigmented or non-pigmented, the latter is asymptomatic for a long time; it grows quickly in the form of a node or superficially; sometimes multiple foci are formed that can merge. The surface of the melanoma is smooth, shiny. In the pigmented form, radially located pigment "paths" or a scattering of pigment are visible on the border of the node. A network of dilated, congested-plethora of vessels is formed around the tumor. As the melanoma grows, its surface ulcerates, and the tumor begins to bleed. Satellites typically form as a result of the formation of seedings and contact with the main tumor node. Non-pigmented seedings are especially dangerous, since the doctor often does not notice them due to their pink color. In half of patients, melanoma grows into the cornea.

Tumor treatment should be started as early as possible. In case of localized melanoma, combined organ-preserving treatment is indicated; local excision and brachytherapy, local chemotherapy with mitomycin C and local block excision (removal of the tumor with surrounding healthy tissues) can be performed. In case of widespread tumor, as well as in case of melanoma of the lacrimal caruncle and semilunar fold, irradiation with a narrow medical proton beam is effective.

The prognosis for conjunctival melanoma is poor. With hematogenous metastasis, the mortality rate reaches 22-30%. With adequate treatment, the 5-year survival rate is 95%. The outcome of treatment largely depends on the location and size of the tumor. For melanomas up to 1.5 mm thick, the prognosis is better. If the tumor thickness reaches 2 mm or more, the risk of regional and distant metastases increases. The prognosis worsens if the tumor spreads to the lacrimal caruncle, fornices and palpebral conjunctiva. With epibulbar melanoma, especially localized in the limbus, the prognosis is more favorable.

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