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The following is a summary of “Conjunctival melanoma: Insights into classification, outcomes, and biomarkers,” published in the February 2024 issue of Dermatology by Shields, et al.

For a study, researchers sought to provide a comprehensive understanding of conjunctival melanoma, including its incidence, clinical presentation, prognostic factors, and potential therapeutic targets.

A thorough review of the literature was conducted to compile data on the incidence, clinical characteristics, AJCC classification, outcomes, and biomarkers associated with conjunctival melanoma.

Conjunctival melanoma is a rare malignancy, with an estimated incidence of approximately 0.5 per 1 million persons per year. It arises from various pre-existing conditions, including nevi (7%), primary acquired melanosis (74%), or de novo without pre-existing conditions (19%). Predominantly affecting individuals with Fitzpatrick skin types I (23%) and II (62%), the tumor typically presents with a cross-sectional diameter of approximately 13 mm and a thickness of 3 mm, involving various ocular regions, with bulbar involvement being the most common (97%). According to AJCC classification, tumors are categorized as T1 (63%), T2 (18%), T3 (20%), and T4 (0%). Older patients (?70 years) tend to present with larger tumors and experience higher rates of recurrence and vision loss. Analysis by AJCC classification revealed increasing T category associated with greater lymph node metastasis (3% versus 13% versus 25%; P < .001), tumor-related systemic metastasis (13% versus 45% versus 40%; P < .001), and tumor-related death (8% versus 22% versus 37%; P < .001). Orbital invasion is associated with significantly higher rates of exenteration, distant metastasis, and death. Biomarker studies have identified mutations in BRAF, NRAS, ATRX, and NF1 associated with conjunctival melanoma.

Conjunctival melanoma posed a significant clinical challenge, with moderate risks of lymph node and systemic metastasis, as well as mortality, depending on tumor features and AJCC classification. Early intervention and targeted therapies directed against identified mutations promise to improve outcomes in patients with this rare malignancy.


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