THE DIAGNOSIS of malignant melanoma, particularly when of gross proportion and situated at the limbus of the eye, is not difficult when it appears as a typical heavily pigmented mass, painless, elevated and fungating in character, vascularized, and with a fixed base. Histological confirmation is essential.
Excisional biopsy of the entire mass is now condoned. Should the tumor be nonmalignant, one may elect to do nothing, or, possibly, to consider local radiation therapy, as recommended by Lederman.1 The usual surgical approach is to remove the eyeball only, by simple enucleation, or by more radical means, such as exenteration. In those cases with definite evidence of metastasis, ocular surgery is not indicated since it does not have value.
Regional node drainage is potentially of inestimable value in directing the surgeon's therapeutic program. The conjunctival membrane and adnexa lymphatics drain principally to the preauricular parotid, superficial and deep cervical lymph chains,
Freiwald MJ, Crump FM. Epibulbar Malignant MelanomaConsideration of Lymphatic Drainage in Surgical Management. JAMA. 1961;176(1):56–57. doi:10.1001/jama.1961.63040140017019b
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