slide1
Download
Skip this Video
Download Presentation
Primary conjunctival melanomas.

Loading in 2 Seconds...

play fullscreen
1 / 32

Primary conjunctival melanomas. - PowerPoint PPT Presentation


  • 118 Views
  • Uploaded on

Primary conjunctival melanomas. Patient profile. 7 patients. 5 females ; 2 males. The female age range was 39-77 (median age 62). The males were aged 44 and 74. All patients had unilateral disease. 4 right eyes and 3 left eyes were affected. 14 primary invasive melanomas

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Primary conjunctival melanomas.' - tamira


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
patient profile
Patient profile
  • 7 patients.

5 females ; 2 males.

The female age range was 39-77 (median age 62).

The males were aged 44 and 74.

All patients had unilateral disease.

4 right eyes and 3 left eyes were affected.

slide6

14 primary

invasive

melanomas

in 7 patients

3 patients

Multiple mm

4 patients

Solitary mm

2 juxta-limbal

bulbar conjunctiva;

2 inferior fornix

and

inferior tarsal conjunctiva.

1 juxta-limbal bulbar,

1 juxtalimbal bulbar and non-bulbar

1 juxtalimbal bulbar and plica involvement.

melanoma thickness
Melanoma thickness
  • 0.1mm to 1.4 mm
  • pT1a to pT2b
  • All cases associated with in-situ MM
  • One case had vascular invasion.
slide11

2002

2010

slide12

19 nodules overall

7 patients

4 patients solitary

3 patients multiple

1-synchronous

2-metachronous

location of nodules
Location of nodules

6 patients

nodules

after primary

Conj mm diag.

1 patient

presented

with nodule

19 nodules

in 7 patients

11 NON-BULBAR

8 BULBAR

Nodule size range 3-9mm

Median-5mm

slide14

Nodules

3-102 months

after first primary

Conj mm

(median 10m)

7 patients

Systemic mets

8-37 m after

First nodule

5 free of systemic

mets

2 developed

systemic mets

Alive

level 1 and 2

neck lymph nodes

intra-parotid lymph node

lung.

Dead

Bone

Liver

Brain

slide27

Evidence that nodules are

Local METS?

2 cases

Developed

Systemic mets

Multiple

and synchronous

Nodules-behaviour

like mets.

Well defined

Cannon ball

1 nodule-necrosis

Eg. Skin mm

In-transits

Well defined Grenz zone

No overlying in-situ MM

argument against mets
Argument against mets.
  • New primaries with once-existent in-situ melanoma, with the latter regressed in response to Mitomycin C and the nodule having been ‘carved out’

Unlikely

  • In one case, the LCM was the presenting feature with no history of prior topical chemotherapy or surgery.
  • Further primary tumours developed in some cases, while on topical chemotherapy and none of these further primary tumours exhibited a well-defined, nodular morphology.
  • One case, the LCM developed 8 years after the primary tumour had been treated and never received MMC.
odd distribution of lcms
Odd distribution of LCMs?
  • Local factors that promote arrest and growth of the LCMs.
  • Surgery scarring and inflammation -damming up of tumour cells-possible but in 1 case, LCM at presentation and some cases LCM remote from surgery site.
  • Seeding by surgery? But 1 case presentation with LCM with no prior surgery history and no nodules at edge of dissection lines.
  • Dormant micromets that disseminate early…grow..?
  • Circulating stem cells that find niche and expand ?
slide30
All of the LCM extravascular,
  • Always extravascular, or whether once intravascular and have exited?
  • Intrinsic blood supply
  • Associated with a lymphocyte cap. Host reaction?

LCM selected a pre-existing lymphoid niche?

  • LCM associated with lymphatic vessels some cases. Intraymphatic spread? Lymphangiogenesis?
systemic mets
Systemic mets.
  • 2 cases.
  • Is LCM a proxy measure for what is happening systemically?
  • Indication for sentinel LN biopsy?
  • Should LCMs be regarded as ‘N’ status in pathological TNM classification (like large bowel adenoca)?
ad