title: Outcomes in 15 patients with conjunctival melanoma treated with adjuvant topical mitomycin C: complications and recurrences.
abstract: OBJECTIVE
  To report the long-term complications and rate of local recurrence in a cohort of patients with histopathologically confirmed conjunctival melanoma (CM) treated with adjuvant topical mitomycin C (MMC).
  
  
  METHODS
  Retrospective, nonrandomized interventional study.
  
  
  METHODS
  Fifteen patients with histopathologically confirmed diagnosis of CM treated with topical MMC.
  
  
  METHODS
  We identified all patients with histopathologically confirmed diagnosis of CM treated with topical MMC between January 1999 and March 2010. Data extracted from the patients' medical records included demographic, clinical, and histopathologic findings; treatments; long-term complications (>6 months) of MMC therapy; recurrent and metastatic disease; and mortality.
  
  
  METHODS
  Prevalence of long-term complications of MMC and development of recurrent disease were assessed.
  
  
  RESULTS
  Fifteen patients (12 female) received topical MMC a median of 2.8 months (0.37-110.9 months) after the diagnosis of CM. Median age at diagnosis was 62 years (29-82 years), and median length of follow-up was 23.8 months (2.2-130.8 months). Most common complications included injection (n=13), tearing (n=10), irritation (n=9), pain (n=9), and limbal stem cell deficiency with keratopathy (n=4). Twelve patients (80%) experienced at least 1 long-term complication, with failure of resolution of symptoms in 7 of these patients. Local recurrence was associated with longer delay to MMC initiation (2 ±8.0 vs. 30.8 ±11 months, P=0.06). Three patients developed metastases. Recurrence was associated with metastatic disease (P=0.001). Exenteration was required in 2 patients, 1 of whom developed metastatic disease and died.
  
  
  CONCLUSIONS
  Careful consideration should be given to the use of adjuvant MMC for the treatment of residual intraepithelial disease after the diagnosis of CM given the risk of potential long-term ocular surface toxicities.
authors.affiliation: Hamilton Eye Institute, Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Lauren C
authors.initials: LC
authors.lastname: Ditta
authors.forename: Yevgeniy
authors.initials: Y
authors.lastname: Shildkrot
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Wilson
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects; D003230:Conjunctival Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage* / Q000009:adverse effects; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D000903:Antibiotics, Antineoplastic; D016685:Mitomycin