Skip to main content Skip to main navigation menu Skip to site footer

Rekurensi tinggi pada melanoma maligna konjungtiva: laporan kasus

  • Ni Putu Mariati ,
  • Putu Yuliawati ,
  • I Wayan Juli Sumadi ,
  • I Made Agus Kusumadjaja ,

Abstract

Introduction: Ocular malignant melanoma is a rare but deadly disease that most often appears in the uvea, conjunctiva or orbit. Melanoma can be asymptomatic or give symptoms and signs depending on development of neoplasm. This case report aims to discuss the clinical sign of conjunctival malignant melanoma and the treatment given to better understand the disease.

Case Report: Female patient, 57 years old complained lump in the left eye since 1 month ago. Red eyes, pain and blurry vision (-). Previously, patients with a history of malignant melanoma in the left eye and had performed surgery 5 times since 2015. Ophthalmology examination obtained visual acuity on right eye 6/18 and left eye 6/45. Anterior segment evaluation of the left eye found mass on palpebra, size 2x1 cm, color according to skin, mobile (-), tenderness (-). In conjunctiva found CVI (+) and symblepharon. There are 3 masses in conjunctiva. First mass in bulbi conjunctival superior to limbus with round shape, diameter 3 mm, brown color and smooth surface. The second mass in superotemporal conjunctival fornix, brownish color, size 1,5x1,5 cm with solid consistency, mobile (+). The third mass in the superior tarsal conjunctival, oval shape, 5x3 mm, brownish color and smooth surface. Lens of right and left eye found hazy. Segmen posterior on both eye within normal limit. Patient was diagnosed with post wide excision + cryotherapy + 5 fu (8 months) + suspected conjunctival tumor ec malignant melanoma + right left eye immature senile cataract. Patient underwent tumor multiple excision + cryotherapy + PA with general anesthesia. The biopsy results showed histomorphology consistent with malignant melanoma. There were no regional or distant metastasis.

Conclusion: There are several therapeutic modalities for conjunctival melanoma, such as wide local excision with adjuvant therapy (brachytherapy, cryotherapy, and the use of topical chemotherapeutic agent like Mytomicin C). If tumor become a multiple recurrence or rapidly growing local tumor, the exenteration is needed.

 

 

Pendahuluan: Melanoma maligna okular merupakan suatu penyakit yang jarang dengan angka kematian yang tinggi dan paling sering muncul pada uvea, konjungtiva maupun orbita. Melanoma dapat bersifat asimptomatis hingga menimbulkan sekumpulan gejala dan tanda tergantung dari perkembangan neoplasma. Laporan kasus ini bertujuan untuk membahas tanda klinis melanoma maligna konjungtiva dan tatalaksana yang diberikan untuk lebih dapat memahami mengenai penyakit ini.

Laporan kasus: Pasien wanita, 57 tahun, mengeluh muncul benjolan pada mata kiri yang disadari sejak 1 bulan yang lalu. Mata merah, nyeri, keluhan kabur (-). Sebelumnya pasien dengan riwayat melanoma maligna pada mata kiri dan telah dilakukan operasi sebanyak 5x sejak tahun 2015. Pemeriksaan oftalmologi didapatkan tajam penglihatan mata kanan 6/18 dan mata kiri 6/45. Evaluasi segmen anterior pada mata kanan ditemukan lensa keruh minimal. Evaluasi segmen anterior mata kiri ditemukan massa pada palpebra, ukuran 2x1 cm, warna sesuai dengan kulit, mobile, padat, nyeri tekan (-). Pada konjungtiva ditemukan conjunctival vascular injection (CVI) (+) dan simblefaron inferior di konjungtiva serta ditemukan 3 buah massa. Massa pertama pada konjungtiva bulbi superior hingga limbus, bentuk bulat, diameter 3 mm, batas tegas, permukaan licin, warna kecoklatan. Massa kedua di konjungtiva fornix superotemporal, warna kecoklatan, teraba bulat, ukuran 1,5x1,5 cm, permukaan rata, konsistensi padat kenyal, mobile, nyeri tekan (-). Massa ketiga di konjungtiva tarsal superior, bentuk oval, uk 5x3 mm, warna kecoklatan, permukaan licin. Lensa keruh minimal dan segmen anterior lain dalam batas normal. Evaluasi segmen posterior mata kanan dan kiri dalam batas normal. Pasien didiagnosis dengan oculi sinistra (OS) post wide eksisi + cryotherapy + 5 fluorouracil (5fu) (8 bulan) + suspek tumor konjungtiva rekuren ec melanoma maligna dan oculi dekstra et sinistra (ODS) KSI dan dilakukan tindakan eksisi tumor multiple + cryotherapy + patologi anatomi (PA) dengan general anesthesia (GA). Hasil histopatologi dari open biopsy sesuai untuk melanoma maligna. Tidak ditemukan adanya metastase regional maupun metastase jauh.

Simpulan: Terdapat beberapa modalitas terapi untuk melanoma konjungtiva yaitu wide local excision dengan terapi adjuvant seperti brachytherapy, cryotherapy, dan penggunaan agen topikal kemoterapeutik (mytomicin C). Apabila dalam perjalanannya penyakit menjadi rekurensi multipel atau tumor lokal yang berkembang pesat maka tindakan eksenterasi sangat diperlukan.

References

  1. Yu G-P, Hu D-N, McCormick S, Finger PT. Conjunctival melanoma: is it increasing in the United States? Am J Ophthalmol. 2003;135(6):800–6. Available from: http://dx.doi.org/10.1016/s0002-9394(02)02288-2
  2. Shields CL, Shields JA. Ocular melanoma: relatively rare but requiring respect. Clin Dermatol. 2009;27(1):122–33. Available from: http://dx.doi.org/10.1016/j.clindermatol.2008.09.010
  3. Rose AM, Luthert PJ, Jayasena CN, Verity DH, Rose GE. Primary Orbital Melanoma: Presentation, Treatment, and Long-term Outcomes for 13 Patients. Front Oncol. 2017;7:316. Available from: https://pubmed.ncbi.nlm.nih.gov/29326884
  4. Pizzutiello R. Review of Radiologic Physics. 4th Edition. WalterHuda, Author. Philadelphia: Lippincott Williams & Wilkins, 2016. Softcover: 336pp. Price: $74.99. ISBN 9781496325082. Med Phys. 2019;46(5):2539. Available from: http://dx.doi.org/10.1002/mp.13473
  5. Missotten GS, Keijser S, De Keizer RJW, De Wolff-Rouendaal D. Conjunctival Melanoma in The Netherlands: A Nationwide Study. Investig Opthalmology Vis Sci. 2005;46(1):75. Available from: http://dx.doi.org/10.1167/iovs.04-0344
  6. Zembowicz A, Mandal R V, Choopong P. Melanocytic Lesions of the Conjunctiva. Arch Pathol Lab Med. 2010;134(12):1785–92. Available from: http://dx.doi.org/10.5858/2009-0522-rar.1
  7. Cekic S, Risimic D, Jovanovic I, Djordjevic-Jocic J. Idiopathic polypoidal choroidal vasculopathy. Vojnosanit Pregl. 2012;69(1):85–9. Available from: http://dx.doi.org/10.2298/vsp1201085c
  8. Shields CL. Conjunctival Nevi. Arch Ophthalmol. 2004;122(2):167. Available from: http://dx.doi.org/10.1001/archopht.122.2.167
  9. Höglund M, Gisselsson D, Hansen GB, White VA, Säll T, Mitelman F, et al. Dissecting karyotypic patterns in malignant melanomas: Temporal clustering of losses and gains in melanoma karyotypic evolution. Int J Cancer. 2003;108(1):57–65. Available from: http://dx.doi.org/10.1002/ijc.11558
  10. Shields CL, Markowitz JS, Belinsky I, Schwartzstein H, George NS, Lally SE, et al. Conjunctival Melanoma. Ophthalmology. 2011;118(2):389-395.e2. Available from: http://dx.doi.org/10.1016/j.ophtha.2010.06.021
  11. Spencer WH. Ophthalmic Pathology and the American Academy of Ophthalmology. Ophthalmology. 1996;103:S109–17. Available from: http://dx.doi.org/10.1016/s0161-6420(96)30769-0
  12. Shields CL, Kaliki S, Al-Dahmash SA, Lally SE, Shields JA. American Joint Committee on Cancer (AJCC) Clinical Classification Predicts Conjunctival Melanoma Outcomes. Ophthalmic Plast Reconstr Surg. 2012;28(5):313–23. Available from: http://dx.doi.org/10.1097/iop.0b013e3182611670
  13. Wong JR, Nanji AA, Galor A, Karp CL. Management of conjunctival malignant melanoma: a review and update. Expert Rev Ophthalmol. 2014;9(3):185–204. Available from: https://pubmed.ncbi.nlm.nih.gov/25580155
  14. Kalemaki MS, Karantanas AH, Exarchos D, Detorakis ET, Zoras O, Marias K, et al. PET/CT and PET/MRI in ophthalmic oncology (Review). Int J Oncol. 2020/01/03. 2020;56(2):417–29. Available from: https://pubmed.ncbi.nlm.nih.gov/31939615
  15. Kenawy N, Lake SL, Coupland SE, Damato BE. Conjunctival melanoma and melanocytic intra-epithelial neoplasia. Eye (Lond). 2012/12/07. 2013;27(2):142–52. Available from: https://pubmed.ncbi.nlm.nih.gov/23222568
  16. Oellers P, Karp CL. Management of Pigmented Conjunctival Lesions. Ocul Surf. 2012;10(4):251–63. Available from: http://dx.doi.org/10.1016/j.jtos.2012.08.002
  17. Misra S, Misra N, Yeshwant Gogri P, Reddy V, Bhandari A. A case of conjunctival malignant melanoma with local recurrence. Australas Med J. 2013;6(6). Available from: http://dx.doi.org/10.21767/amj.2013.1728
  18. Shields CL. Conjunctival MelanomaRisk Factors for Recurrence, Exenteration, Metastasis, and Death in 150 Consecutive Patients. Arch Ophthalmol. 2000;118(11):1497. Available from: http://dx.doi.org/10.1001/archopht.118.11.1497
  19. Finger PT, Czechonska G, Liarikos S. Topical mitomycin C chemotherapy for conjunctival melanoma and PAM with atypia. Br J Ophthalmol. 1998;82(5):476–9. Available from: https://pubmed.ncbi.nlm.nih.gov/9713051
  20. Kurli M, Finger PT. Topical mitomycin chemotherapy for conjunctival malignant melanoma and primary acquired melanosis with atypia: 12 years’ experience. Graefe’s Arch Clin Exp Ophthalmol. 2005;243(11):1108–14. Available from: http://dx.doi.org/10.1007/s00417-004-1080-y
  21. Vora GK, Demirci H, Marr B, Mruthyunjaya P. Advances in the management of conjunctival melanoma. Surv Ophthalmol. 2016/06/16. 2017;62(1):26–42. Available from: https://pubmed.ncbi.nlm.nih.gov/27321895

How to Cite

Mariati, N. P., Yuliawati, P., Sumadi, I. W. J., & Kusumadjaja, I. M. A. (2021). Rekurensi tinggi pada melanoma maligna konjungtiva: laporan kasus. Intisari Sains Medis, 12(3), 1016–1024. https://doi.org/10.15562/ism.v12i3.1091

HTML
60

Total
86

Share

Search Panel

Ni Putu Mariati
Google Scholar
Pubmed
ISM Journal


Putu Yuliawati
Google Scholar
Pubmed
ISM Journal


I Wayan Juli Sumadi
Google Scholar
Pubmed
ISM Journal


I Made Agus Kusumadjaja
Google Scholar
Pubmed
ISM Journal