[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
[Skip to Content Landing]
August 1980

Combined Surgery and Cryotherapy for Diffuse Malignant Melanoma of the Conjunctiva

Author Affiliations

From the Algernon B. Reese Laboratory of the Edward S. Harkness Eye Institute, New York (Drs Jakobiec and Cooper), and the Departments of Ophthalmology and Pathology (Drs Brownstein and Khalil), Medicine (Dr Wilkinson), and Surgery (Dr Shibata), McGill University, Montreal. Dr Jakobiec is now with the Manhattan Eye, Ear, and Throat Hospital, New York.

Arch Ophthalmol. 1980;98(8):1390-1396. doi:10.1001/archopht.1980.01020040242005

• Two patients who had refused exenteration for widespread conjunctival melanoma were treated by a combination of cryotherapy and surgical excisions. Cryotherapy was delivered only to the extensive areas of flat intraepithelial melanocytic proliferation (precancerous melanosis), while the surgical excisions were performed on the focal nodules, representing localized invasive melanoma. In our two patients, the invasive nodules measured, respectively, 1.2 and 1.5 mm in greatest thickness, placing them in a low to borderline risk group for metastasis. Repeated cryoapplications were required to control the widespread flat intraepithelial disease. The conjunctiva tolerated these procedures well because the substantia propria is not sacrificed as it must be in surgical conjunctivectomy, allowing comparatively normal reepithelialization to occur from adjacent zones, after the treated epithelium containing the melanocytes sloughs. No evidence of invasive melanoma (cancerous melanosis) has developed in any of the cryotreated areas of intraepithelial disease (precancerous melanosis); sequential biopsies have established that the atypical melanocytes have disappeared from the epithelium.

Zimmerman LE, Maumencee AE, Reese AB, et al:  Pigmented tumors of the conjunctiva , in Boniuk M (ed): Ocular and Adnexal Tumors . St Louis, CV Mosby Co, 1964, pp 24-48.
Jay B:  Naevi and melanomata of the conjunctiva . Br J Ophthalmol 49:169-204, 1965.Article
Zimmerman LE:  Criteria for management of melanosis . Arch Ophthalmol 76:307-308, 1966.Article
Reese AB:  Precancerous and cancerous melanosis . Am J Ophthalmol 61:1272-1277, 1966.
Silvers DN, Jakobiec FA, Freeman T, et al:  Melanoma of the conjunctiva: A clinicopathologic study , in Jakobiec FA (ed): Ocular and Adnexal Tumors . Birmingham, Ala, Aesculapius Publishing Co, 1978, pp 583-599.
Henkind P:  Conjunctival melanocytic lesions: Natural history , in Jakobiec FA (ed): Ocular and Adnexal Tumors . Birmingham, Ala, Aesculapius Publishing Co, 1978, pp 572-582.
Zimmerman LE:  The histogenesis of conjunctival melanomas , in Jakobiec FA (ed): Ocular and Adnexal Tumors . Birmingham, Ala, Aesculapius Publishing Co, 1978, pp 600-630.
Clark W, Goldman L, Mastrangelo M (eds): Human Malignant Melanoma . New York, Grune & Stratton Inc, 1979.
Kopf A, Bart R, Rodriguez-Sains R, et al: Malignant Melanoma . New York, Masson Publishing Co, 1979.
Breslow A:  Thickness cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma . Ann Surg 172:902-908, 1970.Article
Griffith WR, Green WR, Weinstein GW:  Conjunctival malignant melanoma originating in acquired melanosis sine pigmento . Am J Ophthalmol 75:595-599, 1972.
Torre D:  Cryosurgical treatment of eyelid tumors , in Jakobiec FA (ed): Ocular and Adnexal Tumors . Birmingham, Ala, Aesculapius Publishing Co, 1978, pp 517-524.
Wilkes TD, Fraunfelder FT:  Principles of cryosurgery . Ophthalmic Surg 10:21-30, 1979.
Zacarian SA:  Cryogenics, the cryolesion and the pathogenesis of cryonecrosis , in Zacarian SA (ed): Cryosurgical Advances in Dermatology and Tumors of the Head and Neck . Springfield, Ill, Charles C Thomas Publisher, 1977, pp 3-37.
Fraunfelder FT, Wallace TR, Farris HE, et al:  The role of cryosurgery in external ocular and periocular disease . Trans Am Acad Ophthalmol Otolaryngol 83:713-724, 1977.