Jose J Echegaray1, Gabrielle Yeaney2, Rachel Chen1, Arun D Singh1. 1. Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA. 2. Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA.
Abstract
PURPOSE: To report a case of local metastasis of conjunctival melanoma, which may occur via extravascular migratory metastasis (EVMM), and discuss its clinical relevance in conjunctival melanoma tumor staging and possible management implications. METHODS: Retrospective chart review of a single clinical case with clinicopathologic correlation. RESULTS: A 65-year-old male referred due to local recurrence of conjunctival melanoma at the caruncle was successfully treated after two excisional procedures with negative sentinel lymph node biopsies. Forty-eight months after initial presentation, the patient developed a nodular lesion representing local recurrence in the ipsilateral upper tarsal conjunctiva, distant from the primary tumor site. Histopathology showed nodules in the substantia propria in the absence of primary acquired melanosis. The tumor cells were found along the extravascular surface without intralymphatic or intravascular tumor cells consistent with local metastasis. One possible mechanism is angiotropic microsatellitosis leading to local EVMM. Additional neck CT imaging showed no lymphadenopathy. CONCLUSION: EVMM via angiotropic microsatellitosis is another possible mechanism of noncontiguous local recurrence of conjunctival melanoma. Angiotropic microsatellitosis may represent a high-risk finding possibly related to increased melanoma-related mortality.
PURPOSE: To report a case of local metastasis of conjunctival melanoma, which may occur via extravascular migratory metastasis (EVMM), and discuss its clinical relevance in conjunctival melanoma tumor staging and possible management implications. METHODS: Retrospective chart review of a single clinical case with clinicopathologic correlation. RESULTS: A 65-year-old male referred due to local recurrence of conjunctival melanoma at the caruncle was successfully treated after two excisional procedures with negative sentinel lymph node biopsies. Forty-eight months after initial presentation, the patient developed a nodular lesion representing local recurrence in the ipsilateral upper tarsal conjunctiva, distant from the primary tumor site. Histopathology showed nodules in the substantia propria in the absence of primary acquired melanosis. The tumor cells were found along the extravascular surface without intralymphatic or intravascular tumor cells consistent with local metastasis. One possible mechanism is angiotropic microsatellitosis leading to local EVMM. Additional neck CT imaging showed no lymphadenopathy. CONCLUSION: EVMM via angiotropic microsatellitosis is another possible mechanism of noncontiguous local recurrence of conjunctival melanoma. Angiotropic microsatellitosis may represent a high-risk finding possibly related to increased melanoma-related mortality.
Authors: Ludwig M Heindl; Carmen Hofmann-Rummelt; Werner Adler; Jacobus J Bosch; Leonard M Holbach; Gottfried O H Naumann; Friedrich E Kruse; Claus Cursiefen Journal: Ophthalmology Date: 2011-08-11 Impact factor: 12.079
Authors: Guy S Missotten; Sander Keijser; Rob J W De Keizer; Didi De Wolff-Rouendaal Journal: Invest Ophthalmol Vis Sci Date: 2005-01 Impact factor: 4.799
Authors: Carol L Shields; Swathi Kaliki; Saad A Al-Dahmash; Sara E Lally; Jerry A Shields Journal: Ophthalmic Plast Reconstr Surg Date: 2012 Sep-Oct Impact factor: 1.746
Authors: F A Jakobiec; G Buckman; L E Zimmerman; F G La Piana; M R Levine; A P Ferry; J B Crawford Journal: Ophthalmology Date: 1989-07 Impact factor: 12.079
Authors: Jeffrey Weber; Mario Mandala; Michele Del Vecchio; Helen J Gogas; Ana M Arance; C Lance Cowey; Stéphane Dalle; Michael Schenker; Vanna Chiarion-Sileni; Ivan Marquez-Rodas; Jean-Jacques Grob; Marcus O Butler; Mark R Middleton; Michele Maio; Victoria Atkinson; Paola Queirolo; Rene Gonzalez; Ragini R Kudchadkar; Michael Smylie; Nicolas Meyer; Laurent Mortier; Michael B Atkins; Georgina V Long; Shailender Bhatia; Celeste Lebbé; Piotr Rutkowski; Kenji Yokota; Naoya Yamazaki; Tae M Kim; Veerle de Pril; Javier Sabater; Anila Qureshi; James Larkin; Paolo A Ascierto Journal: N Engl J Med Date: 2017-09-10 Impact factor: 91.245