Conjunctival Melanoma With Corneal Invasion

Report our approach in a case of conjunctival melanoma with corneal invasion.

The case was conducted in Médicos de Olhos SA, Curitiba, Brazil 

77-year-old female presented to the emergency department complaining about a subconjunctival hemorrhage in her left eye (LE). Ophthalmologic examination revealed an elevated pigmented lesion in the superior and temporal limbus, leading to the referral to the cornea department for further evaluation.

During an elective consultation, she reported progressive lesion growth over approximately 6 months. Best-corrected visual acuity was 20/20 in both eyes. Slit-lamp examination revealed an elevated pigmented lesion involving the conjunctiva and the limbus (360°), extending into the superior fornix with temporal corneal invasion. The patient was pseudophakic. Intraocular pressure and retinal examination were normal. Anterior segment optical coherence tomography of the cornea showed a hyperreflective lesion invading 160 microns of the cornea, with a thickness of approximately 360 micrometers.

Given the suspicion of conjunctival melanoma, surgical excision was performed, aiming to remove as much of the lesion as possible. A 360-degree peritomy was carried, with excision of approximately 160 microns of corneal tissue. The material was sent to histopathological analysis, followed by lamellar and limbal transplantation with cryotherapy applied.

Histopathological examination confirmed a diagnosis of lentiginous conjunctival melanoma, non-ulcerated, with corneal invasion, Breslow thickness of 0.5 mm, and Clark level II. The patient was referred to an oncologist and remains under follow-up.

In suspected cases of conjunctival melanoma, early biopsy is essential to appropriate patient management.