A TYPICAL CASE OF CONJUNCTIVAL MELANOMA: PRESENTATION AND MANAGEMENT.

Conjunctival melanoma is a relatively rare malignant tumor. It is considered a multifactorial disease. Exposure to ultraviolet light is the most recognized risk factor. Anatomopathologically, it is characterized by a tumoral proliferation of atypical melanocytes. It can develop on a pre-existing lesion or appear on healthy conjunctiva, known as "de novo" melanoma. 
It can involve any portion of the conjunctiva, and extend to the surface of the cornea. Involvement may be multifocal.

we report the case of a man representing a conjunctival melanoma

A 68-year-old man with no prior history. He presented with a conjunctival lesion that had been evolving for 4 months. Ophthalmological examination revealed a pigmented mass in the bulbosuperior conjunctiva of the left eye. The lesion was pedunculated, extending from the conjunctiva to the limbus with a polylobulated appearance, and richly vascularized with a soft consistency; CT scan of the orbital region showed no intraocular extension.A complete resection was performed. With cryo-application of the excision bed.
Histological examination revealed a conjunctival malignant melanoma measuring 0.7x0.4x0.3 cm.Extraocular extension was assessed as normal. The evolution was favorable with a 2-year follow-up.

Conjunctival melanoma is a rare tumor, accounting for just 2% of all ocular malignancies. Melanoma can remain asymptomatic for a long time, or be discovered incidentally during a routine ophthalmological check-up. It generally affects men and women of all ages, with peak incidence between the ages of 40 and 50.
Treated conjunctival melanoma frequently recurs, with a 50% recurrence rate at 10 years.  Overall mortality varies between 25% and 36% at 10 years.

Prognostic factors related to the tumor are its location and histological type. Localization in the bulbar conjunctiva in the area of the palpebral cleft seems to have a better prognosis, as it is diagnosed earlier. UV rays are widely incriminated in the pathogenesis of melanoma, while the role of trauma is still controversial.
Tumors of the limbus and bulbar conjunctiva have a better prognosis than those of the cul-de-sac and caruncle.

The first stage of treatment is surgical removal of the lesion, with adjuvant therapy such as radiotherapy to reduce the risk of recurrence. 
Despite treatment, the prognosis remains severe, as recurrences are frequent, hence the importance of close ophthalmological follow-up with careful examination of the adnexa. 
In addition, an extension work-up is necessary, with whole-body imaging and a full dermatological examination to detect cutaneous melanoma.