title: Malignant melanoma of the conjunctiva with intraocular extension: a clinicopathological study of three cases.
abstract: BACKGROUND
  Malignant melanoma of the conjunctiva is a rare tumour with an unpredictable behaviour, characterised by the high risk of local recurrence and metastatic spread. Intraocular extension of a conjunctival melanoma is rare. We present three cases of primary conjunctival melanoma with intraocular extension.
  
  
  METHODS
  Three patients presented with primary conjunctival melanomas, which either arose at or later involved the limbus on a background of primary acquired melanosis. Despite adequate primary local excision and adjuvant chemotherapy, all three patients experienced several recurrences, requiring further surgery. Two of the patients had excision of the tumour that required superficial keratectomy. One of these patients then required two further procedures in which the anterior chamber was breached.
  
  
  RESULTS
  All three patients ultimately required enucleation or exenteration to control local disease. All three specimens showed intraocular extension.
  
  
  CONCLUSIONS
  The management of conjunctival melanoma can be difficult. In addition to local recurrence and metastases, limbal melanomas may rarely show intraocular extension, particularly if surgery to excise the tumour requires the removal of Bowman's membrane. Regular follow-up of these patients is mandatory.
authors.affiliation: Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, Scotland, UK.
authors.forename: Teresa
authors.initials: T
authors.lastname: Sandinha
authors.forename: Heather
authors.initials: H
authors.lastname: Russell
authors.forename: Ewan
authors.initials: E
authors.lastname: Kemp
authors.forename: Fiona
authors.initials: F
authors.lastname: Roberts
mesh_terms: D000368:Aged; D003230:Conjunctival Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D015353:Eye Enucleation; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology*