Conjunctival Melanoma: A Clinical Review and Update
1
National Specialist Ophthalmic Pathology Service, Liverpool Clinical Laboratories, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8YE, UK
2
St Paul’s Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8YE, UK
3
Department of Eye and Vision Science, Institute of Life Course and Medical Science, University of Liverpool, Liverpool L7 8TX, UK
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(18), 3121; https://doi.org/10.3390/cancers16183121
Submission received: 19 July 2024
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Revised: 6 September 2024
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Accepted: 9 September 2024
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Published: 10 September 2024
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Corrected: 5 November 2024
(This article belongs to the Special Issue Current Progress and Research Trends in Ocular Oncology)
Simple Summary
Conjunctival melanoma (Co-M) is a rare and aggressive eye surface cancer. It is often misdiagnosed or overlooked, leading to late diagnosis. Co-M can cause sight loss and even eye loss, impacting quality-of-life. The numbers of new cases globally are rising at alarming rates. There is no standard treatment for Co-M and management varies between eye cancer centres. In ~25% of cases the cancer spreads elsewhere in the body, which can lead to death. The aim of this review is to concisely present what is currently known about Co-M presentation, its development and progression, clinical management and outcomes, and finally summarise future directions for research into novel therapies.
Abstract
Conjunctival melanoma (Co-M) is an aggressive, invasive eye and eyelid cancer. Its global incidence of ~1 in a million is increasing at a rate ratio of ~1.4, but this rises sharply in over 65-year-olds. Although rare, Co-M has a devastating impact on the lives of those who develop it. Co-M is often misdiagnosed or overlooked, leading to vision loss either from the destructive effects of the tumour or side effects of therapy, facial disfigurement from radical surgery, and death from metastases. Due to its rarity, there is limited evidence for diagnosis and management; hence, there is no standardised treatment and not all cases are referred to a specialised ocular oncology centre. Recent progress in cancer immunology and genetics have revolutionised the treatment of cutaneous melanomas, which share some similarities to Co-M. Importantly, a better understanding of Co-M and its precursor lesions is urgently needed to lead to the development of novel targeted and immunotherapies both for local tumour control and disseminated disease. This review aims to provide a comprehensive clinical overview of the current knowledge regarding Co-M, its epidemiology, pathogenesis, presentation, diagnosis and recent changes in the classification of its precursor lesions, management, and recent advances in novel biological therapies for personalised treatment of this disease.
