The standard treatment for conjunctival melanoma is surgical excision with cryotherapy for smaller lesions and exenteration for larger lesions involving the orbit. Immunotherapy is studied extensively for cutaneous melanoma but its use in ocular melanoma is still being investigated. Herein we report a patient treated with systemic pembrolizumab (humanized antibody that blocks programmed cell death 1 [PD-1]), as the affected eye was the only seeing eye.
A man in his 60s presented with recurrent conjunctival melanoma of the right eye that was treated 18 months earlier with wide surgical excision and cryotherapy. On examination, his visual acuity was 20/40 OD and 20/200 OS (poor vision from prior trauma). Anterior segment examination showed a recurrent conjunctival melanoma affecting the inferotemporal fornix and anterior orbit (Figure, A) and nasal limbus (Figure, B). Magnetic resonance imaging showed tumor invading the anterior orbit inferotemporally with no intraocular invasion. The options were discussed with the patient and exenteration was offered but in view of the chronic poor vision in the left eye, the patient elected for a more conservative approach.
Kini A, Fu R, Compton C, Miller DM, Ramasubramanian A. Pembrolizumab for Recurrent Conjunctival Melanoma. JAMA Ophthalmol. Published online July 13, 2017. doi:10.1001/jamaophthalmol.2017.2279