BACKGROUND: Conjunctival malignant melanoma (CMM) is so rare that there are no certain guidelines for its treatment. Factors influencing its prognosis include region of onset, tumor thickness, lymph node metastasis, and distant metastasis. Whether regional lymph node metastasis is present or not is one of the most powerful factors for predicting recurrence in and survival of patients with CMM. METHODS: A 72-year-old man with conjunctival malignant melanoma at the lacrimal caruncle was underwent sentinel lymph node (SLN) biopsy by preoperative lymphoscintigraphy and intraoperative vital blue mapping. RESULTS: A blue-dyed node could be identified in the superficial lobe of the parotid gland. A split half of the cropped SLN was immediately submitted to rapid pathological examination. After confirming no metastasis, it was decided not to perform lymph node dissection. The final diagnosis was pT3N0M0. Neither recurrence nor distant metastasis has been observed for 7 years after the operation. CONCLUSIONS: We were able to evaluate N (lymph node metastasis) in the TNM classification accurately. SLN may facilitate N classification and decisions regarding employment of appropriate lymph node dissection as well as combined therapy after operation.
BACKGROUND:Conjunctival malignant melanoma (CMM) is so rare that there are no certain guidelines for its treatment. Factors influencing its prognosis include region of onset, tumor thickness, lymph node metastasis, and distant metastasis. Whether regional lymph node metastasis is present or not is one of the most powerful factors for predicting recurrence in and survival of patients with CMM. METHODS: A 72-year-old man with conjunctival malignant melanoma at the lacrimal caruncle was underwent sentinel lymph node (SLN) biopsy by preoperative lymphoscintigraphy and intraoperative vital blue mapping. RESULTS: A blue-dyed node could be identified in the superficial lobe of the parotid gland. A split half of the cropped SLN was immediately submitted to rapid pathological examination. After confirming no metastasis, it was decided not to perform lymph node dissection. The final diagnosis was pT3N0M0. Neither recurrence nor distant metastasis has been observed for 7 years after the operation. CONCLUSIONS: We were able to evaluate N (lymph node metastasis) in the TNM classification accurately. SLN may facilitate N classification and decisions regarding employment of appropriate lymph node dissection as well as combined therapy after operation.