General Information: Malignant Conjunctival Tumors

Malignant cancers can grow on the surface of the eye. They usually start from the membrane that covers most of the eye called the conjunctiva. The most common conjunctival cancers are squamous carcinoma, malignant melanoma - PAM complex, and lymphoma.

Squamous carcinoma of the conjunctiva can form a nodule or diffusely spread out over the surface of the eye. Squamous conjunctival cancers rarely metastasize to other parts of the body, but they can invade around and into the eye, as well as behind the eye into the orbit and sinuses.

Malignant melanoma can start as a conjunctival nevus, arise as newly formed pigmentation called primary acquired melanosis (PAM), or just appear as a new tumor within the conjunctiva. A simple biopsy can determine whether a pigmented conjunctival tumor is a benign nevus, primary acquired melanosis, or conjunctival melanoma.

Both squamous carcinomas and malignant conjunctival melanomas should be removed or destroyed.

Lymphoma can also occur in the conjunctiva. These tumors look like red or salmon-colored patches on the eye and can be the first sign of systemic lymphoma. Dr. Shome usually biopsies lymphoid tumors so that a pathologist can perform special immunologic and genetic studies on the tumor cells. These techniques are used to determine if the tumor is benign or malignant. Patients with lymphoid conjunctival tumors should have a complete medical check up and be examined by a hematologist-oncologist.

Symptoms
Most conjunctival tumors do not cause symptoms. Patients typically seek medical attention because they notice a discoloration on the eye or extension of the tumor onto the cornea. Conjunctival tumors can also be found by an eye care specialist during a routine eye examination.

Diagnosis
Most small benign-appearing conjunctival tumors can be photographed and followed for evidence of growth prior to biopsy or treatment. If they are raised, hypervascular or extend onto the cornea a biopsy is reasonable.

Evaluation of the biopsy specimen should be performed by an experienced ophthalmic pathologist. If there isn't an ophthalmic pathologist in your area, you can request that the histopathology slides be sent for second opinion.

Treatments
Small tumors can be completely removed, and if they are found to be either squamous carcinoma or malignant melanoma, additional cryotherapy (freezing) may be necessary.

Dr. Shome uses specialized "Finger-tip" cryotherapy probes to uniformly freeze large surfaces of the eye with minimal intraocular penetration.

Conjunctival melanoma and squamous carcinoma can be difficult to treat if they occur in multiple spots on the eye. In these cases, even surgical removal with freezing therapy may not control the tumor.

Several groups of oncologists are currently investigating the use of chemotherapy eye-drops for patients with conjunctival melanoma. Chemotherapy eye-drops treat the entire surface of the eye, are less dependent upon defining the tumors edges, and may decrease the chance of scarring after surgery.

Systemic lymphoma can usually be treated with standard chemotherapy that is also likely to cure malignant ocular lymphomas. If the eye is the only site of malignant lymphoma, external beam radiation therapy is commonly employed.