背景:眼睛很少发生皮肤恶性黑色素瘤,通常在眼睑或结膜。结膜恶性黑素瘤更为罕见。大多数黑素瘤是深色的,因为它们是色素沉着的。然而,无色素性结膜恶性黑色素瘤,一种罕见的癌症变体,很难准确诊断。
方法:我们介绍了两例白人白人瑞典裔女性,她们被诊断为眼睛结膜单侧无色素性恶性黑色素瘤。在第一种情况下,病人是一名81岁的女性,左眼有红肿和异物感。最初的诊断是眼睑炎。进行了三次活检,表现为眼睑和结膜的恶性黑色素瘤。不幸的是,眼睛和轨道的其余部分无法保存,患者不得不接受眼眶切除术。在第二种情况下,病人是个50岁的女人,肿瘤位于左眼颞结膜。最初的诊断是pinguecula,但在手术的时候,医生怀疑结膜上皮内瘤变。肿瘤没有完全切除,所以使用了辅助近距离放射治疗和局部化疗。眼睛被保存下来。在诊断时均未检测到颈部和/或肺转移。
结论:当眼和/或眼睑存在肿瘤时,应怀疑结膜无色素性恶性黑色素瘤。通过怀疑无色素性恶性黑色素瘤,治疗的延迟可以缩短。尽快治疗它们对于将转移风险降至最低至关重要。
BACKGROUND: Cutaneous malignant melanomas rarely occur in the eye, usually in the eyelids or the conjunctiva. Conjunctival malignant melanomas are even rarer. Most melanomas are dark in color as they are pigmented. However, amelanotic conjunctival malignant melanomas, a scarce variant of the cancer, can be challenging to diagnose accurately.
METHODS: We present two cases of white Caucasian Swedish-born women who were diagnosed with unilateral amelanotic malignant melanoma in the conjunctiva of the eye. In the first case, the patient was an 81-year-old woman who was suffering from redness and foreign body sensation in the left eye. The initial diagnosis was blepharitis. Three biopsies were taken, which showed malignant melanoma in the eyelid and the conjunctiva. Unfortunately, the eye and the rest of the orbit could not be saved, and the patient had to undergo an orbital exenteration. In the second case, the patient was a 50-year-old woman, and the tumor was localized in the temporal conjunctiva of the left eye. The initial diagnosis was pinguecula, but at the time of surgery, the physician suspected conjunctival intraepithelial neoplasia. The tumor was not completely removed, so adjuvant brachytherapy and local chemotherapy were used. The eye was preserved. No neck and/or lung metastasis was detected in either case at the time of diagnosis.
CONCLUSIONS: Conjunctival amelanotic malignant melanomas should be suspected when tumors are present in the eye and/or the eyelids. By suspecting amelanotic malignant melanoma, the delay in treatment can be shortened. Treating them as soon as possible is essential to minimize the risk of metastasis.