Is melanoma on the cornea contained or does the individual remain at risk for metastatic disease?

Melanoma on the Cornea: Risk of Metastatic Disease

Melanoma on the cornea is not contained and the individual remains at risk for metastatic disease, requiring appropriate surveillance and management.

Understanding Ocular Melanoma

• Ocular melanoma is the second most common type of melanoma after cutaneous melanoma and the most common primary intraocular malignant tumor in adults 1
• Conjunctival melanoma (which includes corneal involvement) is rare but has an increasing incidence, occurring mostly among white adults 1
• In the majority of cases, conjunctival melanoma originates from preceding primary acquired melanosis 1

Risk of Metastatic Disease

• Conjunctival melanoma tends to spread to other adnexal structures and has metastatic potential 2
• Patients with ocular melanomas, including those affecting the cornea, remain at risk for metastatic disease even after successful local treatment 3
• Approximately 50% of patients with ocular melanoma develop metastatic disease despite successful eradication of the primary tumor 3
• The prognosis of patients with metastatic ocular melanoma remains poor due to lack of effective systemic therapy 1

Diagnostic Considerations

• Melanoma on the cornea typically presents as a painless, flat or nodular, brown or fleshy-pink lesion 2
• Enlargement of the lesion, presence of blood vessels, or thickening often trigger an office visit 2
• Diagnosis is typically established by clinical examination with great accuracy in most cases 1

Risk Factors

• Significant UV exposure is a risk factor for conjunctival melanoma 2
• Previous history of melanoma increases risk 2
• Previous primary acquired melanosis or Nevus of Ota are predisposing factors 2
• Fair skin that sunburns easily and inability to tan are associated with increased risk 2

Treatment Approaches

• Current standard treatment for conjunctival melanoma is wide local excision with adjuvant therapy 1
• Adjuvant therapies include brachytherapy, cryotherapy, and topical application of chemotherapeutic agents 1
• Local treatment of ocular melanoma has improved with increased use of conservative methods and preservation of the eye 1
• Despite improved local control, survival rates have remained largely unchanged 1

Surveillance and Follow-up

• Lifetime dermatologic surveillance is recommended for all patients with melanoma due to the risk of metastatic disease 2
• The frequency of dermatologic surveillance should be determined individually based on risk factors 2
• Skin examination and surveillance at least once a year for life is recommended 2
• For patients with metastatic disease, treatment of the CNS disease usually takes priority to prevent complications 2

Prognostic Factors

• Recent advances in cytogenetics and genetics have enhanced prognostication and enabled determination of tumors with high metastatic potential 1
• Metastatic disease remains the leading cause of death among patients with ocular melanoma 1
• Metastases from ocular melanoma are most frequently localized to the liver 4

Clinical Implications

• Better understanding of underlying genetic and molecular abnormalities in ocular melanomas provides opportunities for development of targeted therapy 1
• As with other melanomas, early detection and treatment could be critical for positive long-term survival outcomes 5
• There is an unmet medical need for early treatment of small melanocytic lesions or small melanomas in the eye to achieve local disease control and potentially prevent metastases 5