[Adjuvant therapy and interdisciplinary follow-up care of conjunctival melanoma].
BACKGROUND
Despite microscopically controlled tumor excision, malignant melanomas of the conjunctiva have a propensity for local recurrence, lymphatic spread and distant metastases.


OBJECTIVE
This review outlines the options of adjuvant therapy as well as the structure of interdisciplinary follow-up care for patients with conjunctival melanoma.


METHODS
The study provides a PubMed literature review and own clinical results.


RESULTS
In conjunctival melanoma complete tumor excision using a minimal touch technique should always be combined with adjuvant therapy, such as cryotherapy, radiotherapy, topical chemotherapy and/or immunotherapy. For locally circumscribed lesions of the bulbar conjunctiva adjuvant brachytherapy can be supplemented and for non-bulbar, extensive, diffuse or multilocular tumor growth, complementary adjuvant topical mitomycin C therapy or proton radiotherapy can be used. Novel adjuvant approaches include topical interferon alpha-2b immunotherapy, topical vascular endothelial growth factor (VEGF) inhibitors or in cases of BRAF mutations personalized therapy using selective BRAF inhibitors or in combination with mitogen-activated protein kinase (MAPK) and extracellular signal-regulated kinase (ERK), MAPK/ERK (MEK) inhibitors. All patients should be integrated into an interdisciplinary follow-up care program including quarter yearly checkups in the first 5 years and psycho-oncological healthcare.


CONCLUSIONS
Following microscopically controlled tumor excision, adjuvant treatment using cryotherapy, radiotherapy, topical chemotherapy and/or immunotherapy as well as interdisciplinary follow-up care are mandatory for the modern management of patients with conjunctival melanoma.
Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Straße 62, 50924, Köln, Deutschland. ludwig.heindl@uk-koeln.de.|Centrum für Integrierte Onkologie (CIO) Köln-Bonn, Köln, Deutschland. ludwig.heindl@uk-koeln.de.
L M
LM
Heindl
Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Straße 62, 50924, Köln, Deutschland.
K R
KR
Koch
Centrum für Integrierte Onkologie (CIO) Köln-Bonn, Köln, Deutschland.|Klinik und Poliklinik für Dermatologie und Venerologie, Universität zu Köln, Köln, Deutschland.
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M
Schlaak
Centrum für Integrierte Onkologie (CIO) Köln-Bonn, Köln, Deutschland.|Klinik und Poliklinik für Dermatologie und Venerologie, Universität zu Köln, Köln, Deutschland.
C
C
Mauch
Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Straße 62, 50924, Köln, Deutschland.|Centrum für Integrierte Onkologie (CIO) Köln-Bonn, Köln, Deutschland.
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Cursiefen
D000359:Aftercare; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D059248:Chemoradiotherapy / Q000379:methods*; D003230:Conjunctival Neoplasms / Q000175:diagnosis / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D008545:Melanoma / Q000175:diagnosis / Q000628:therapy*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D010348:Patient Care Team; D016896:Treatment Outcome
D000970:Antineoplastic Agents
Conjunctiva; Malignant melanoma; Metastasis; Recurrence; Tumor