To analyse the data of a cohort of patients with conjunctival melanoma in order to analyse risk and guarding factors and to investigate the impact on metastatic disease with and without adjuvant therapy. We have retrospectively analysed the impact of clinical aspects and adjuvant therapies after tumour excision or biopsy in 167 patients cared for at the University Hospital Essen and the University Hospital Tübingen, Germany. Clinical as well as histopathological data and therapeutic approaches were analysed with regard to regional (lymphatic) and/or distant (haematogenous) spread during follow-up. The Kaplan-Meier estimate method was used to analyse survival and the Cox regression hazard model to define the probability of metastases depending on different factors. P value of <0.05 was considered statistically significant. 167 cases of malignant conjunctival melanoma were retrospectively analysed. The patients received treatment and were followed up for 78.3±67.5 months. Local tumour recurrence occurred in n=79 patients (47.3%) after a mean of 41.5±70.33 months. 30 patients (37.9%) with a recurrence had not received adjuvant therapy. The overall rate of metastasis was 24.5% (n=41). In n=31 cases, regional lymphatic metastases were found after a follow-up of 48.9±63.5 months; in n=24 cases, distant metastases were found, occurring after 55.5±67.4 months. In n=14, the metastatic disease took both pathways. Ruthenium-106 brachytherapy performed in localised melanoma of the bulbar conjunctiva showed a relevant effect of decreasing the risk for haematogenous metastases by 74% (HR=0.256, p=0.003). 4 out of 54 patients developed distant metastases. In conjunctival melanoma, it is important to perform an adjuvant therapy after excision. This reduces not only local recurrences but also significantly the risk for haematopoietic spread.

This case report describes invasion of a laser-assisted in situ keratomileusis (LASIK) flap interface by conjunctival malignant melanoma in a male patient aged 71 years.

Most malignant melanomas occurring in the parotid gland are presumed to be of metastatic origin from cutaneous, sporadically mucosal, or ocular primary sites in the head and neck region. We present an unusual case of a patient with a history of conjunctival malignant melanoma and subsequent metastasis to the parotid gland. A 39-year-old East Slavic male patient presented with a 6-month history of a gradually enlarging, painless swelling of the left preauricular area. The clinical examination disclosed a firm, hardly movable mass over the central part of the left parotid gland with no overlying skin changes. Fine-needle aspiration biopsy revealed a cytological image of a nonepithelial malignant tumor. Collecting a thorough past medical history unveiled that the patient underwent the surgical excision of the ipsilateral conjunctival nevus a few years earlier, with subsequent lesion recurrence and transformation into conjunctival malignant melanoma, treated with a wide local excision and an oral mucosa transplant. No signs of local melanoma recurrence or distant metastases were observed at the time of presentation. Left-sided total parotidectomy with the subsequent ipsilateral neck dissection was performed. Histopathological examination revealed melanoma metastasis to the intraparotid lymph node without extranodal extension. The patient was then qualified for adjuvant immunotherapy and remained disease-free at the 8-month follow-up. In the case of a suspected malignancy within the parotid gland, exhaustive medical history taking and analysis of the patient's previous photographs might direct to the malignant melanoma diagnosis. The high potential for regional and distant metastasis in individuals with conjunctival malignant melanoma underscores the significance of ongoing research to enhance the understanding of its biological behavior and develop a standardized algorithm for its management and surveillance.

Conjunctival melanoma is a rare yet aggressive ocular surface malignancy, with an incidence of approximately 0.2-0.8 cases per million individuals annually. It predominantly affects older adults, making its occurrence in younger individuals exceedingly rare and diagnostically challenging. We report a 30-year-old Syrian male presenting with a progressively enlarging pigmented lesion on the temporal-inferior conjunctiva of the right eye. The lesion, noted since adolescence, demonstrated significant growth over the past 3 years. Comprehensive clinical assessment and imaging studies confirmed the presence of a well-vascularized, mobile conjunctival lesion, with no evidence of intraocular extension. Surgical excision with 1 mm safety margins was performed, followed by ocular surface reconstruction using a cryopreserved amniotic membrane graft. Histopathological analysis revealed a malignant melanoma with epithelioid and spindle cell morphology and tumor-free margins. Postoperative recovery was uneventful, with full epithelialization by 1 week and no evidence of recurrence at the 1-year follow-up. Timely diagnosis and a multidisciplinary surgical approach are essential for achieving optimal outcomes in conjunctival melanoma, particularly in young patients. Complete excision with negative margins combined with amniotic membrane grafting ensures effective oncologic control and functional ocular surface restoration.

Conjunctival malignant melanoma is an aggressive tumor with the potential for metastasis and death. It is rare in the black population because of the protective effect of melanin. Metastases are usually to regional lymph nodes, most commonly the preauricular nodes, deep cervical lymph nodes, and the salivary gland. We described the case of a 41-year-old black African woman who presented to our ophthalmology clinic with a painless, right medial pigmented bulbar conjunctival swelling and right preauricular and submandibular swelling. Two years ago, she had similar swelling at the same location in the right eye. She subsequently underwent surgical excision under general anesthesia. Histology of both tissues showed proliferating malignant melanocytes that showed heavy pigmentation disposed of in solid nests, tongues, and sheets obscuring cellular details in these areas. Immunohistochemistry showed tumor cells to stain for HMB45 and Melan A. This led us to conclude that the tumor was a malignant melanoma. The patient died a year after making the diagnosis. Conjunctival melanoma is a rare ocular malignancy that should be considered in cases of pigmented lesions of the eye, especially in people with dark pigmentation. Primary acquired melanosis with atypia or a nevus are known as preexisting melanocytic lesions from which conjunctival melanomas might develop. Metastases are often to preauricular and cervical lymph nodes as well as to the salivary gland. This demonstrates the significance of early presentation, thorough history taking, physical examination, and surgical excision for histopathology.