title: Separate Primary Melanomas of the Bulbar Conjunctiva and Eyelid Skin: Clinical Implications of Multiple Primary Melanomas.
abstract: OBJECTIVE
  We report a patient with previous in situ melanoma of the forehead skin who was referred for treatment of a bulbar conjunctival melanoma and a separate superficially invasive melanoma of the eyelid skin, and we offer a review of the biological and clinical implications of patients who have multiple primary melanomas.
  
  
  METHODS
  This article offers a clinicopathological correlation with a review of the relevant literature.
  
  
  RESULTS
  An 80-year-old white man was referred for evaluation of a suspicious conjunctival tumor and a lower-eyelid lesion. Excisional biopsies revealed that both were primary melanomas arising within in situ disease. Over the span of 25 years, the patient had three separate foci of in situ melanoma, two of which spawned invasive melanoma.
  
  
  CONCLUSIONS
  Separate melanomas arising from the bulbar conjunctiva and eyelid skin have rarely been reported. Multiple primary melanomas of the skin, however, are not uncommon. Based on studies of persons with multiple cutaneous melanomas, the prognosis is best predicted by the tumor with the greatest depth of invasion. Patients with multiple melanomas should be examined for dysplastic nevi, additional cutaneous melanomas, and screened periodically for future lesions. Ongoing studies enrolling patients with multiple primary melanomas are attempting to generate insights into low-penetrance susceptibility genes.
authors.affiliation: Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Fla., USA.
authors.forename: Frances A
authors.initials: FA
authors.lastname: Jacinto
authors.affiliation: Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Fla., USA.
authors.forename: George H
authors.initials: GH
authors.lastname: Fisher
authors.affiliation: Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Fla., USA.
authors.forename: Edgar M
authors.initials: EM
authors.lastname: Espana
authors.affiliation: Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Fla., USA.
authors.forename: Ilya M
authors.initials: IM
authors.lastname: Leyngold
authors.affiliation: Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Fla., USA; Department of Pathology and Cell Biology, Morsani College of Medicine, University of South Florida, Tampa, Fla., USA.
authors.forename: Curtis E
authors.initials: CE
authors.lastname: Margo
keywords: Conjunctival melanoma; Eyelid; Melanoma