[Management of corneo-conjunctival malignant melanoma with "no touch technique" surgical excision and corneoscleral lamellar keratoplasty].
OBJECTIVE
To study the management of "no touch technique" surgical excision and corneoscleral lamellar keratoplasty in the treatment of corneo-conjunctival malignant melanoma.


METHODS
Surgical excision for corneo-conjunctival malignant melanoma in six cases, from October 1989 to January 2004 in Zhongshan Ophthalmic Center, were performed. The entire tumors were removed in one piece without touching the tumor (no touch technique). The incision was outlined 4-6 mm outside the pigmented conjunctival mass, and 2 mm outside the corneal component. Dissecting deep enough without any tumor cell left to yield a tumor-free bed. After surgical incision, the host eyeball defect was covered with partial or total corneoscleral lamellar graft from fresh donor, and the conjunctiva defect was covered with or without amniotic membrane transplantation. All the patients were followed up to 6 months.


RESULTS
The tumors in the remaining conjunctival margins were completely removed by local dissection combined with cryotherapy in the six cases. Three cases were treated with partial corneoscleral lamellar keratoplasty, two cases with total corneoscleral lamellar keratoplasty and one case with total corneoscleral lamellar keratoplasty plus amniotic membrane transplantation. All cases were subsequently treated with 0.01% thiotepa eyedrops and supplemental dacarbazine chemotherapy. At the average 43.5 months follow-up time (14.6 years to 6 months), no evidences of local recurrence of malignant melanoma or distant metastasis were observed.


CONCLUSIONS
The clinical study suggests that using surgical excision of "no touch technique" to remove tumor in whole piece with corneoscleral lamellar keratoplasty is effective in the treatment of corneo-conjunctival malignant melanoma.
Chen
Jia-Qi
JQ
Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China. gdeye@gzsums.edu.cn
Sun
Ming-xia
MX
Sha
Xiang-yin
XY
Zhang
Ping
P
Lin
Yue-sheng
YS
Li
Hui
H
Liu
Yong-min
YM
Chen
Long-shan
LS
D000328:Adult; D000368:Aged; D003230:Conjunctival Neoplasms / Q000601:surgery*; D003316:Corneal Diseases / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016850:Limbus Corneae / Q000601:surgery*; D008297:Male; D008548:Melanosis / Q000601:surgery*; D008875:Middle Aged; D016896:Treatment Outcome