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Br J Ophthalmol. 1994 July; 78(7): 520–528.
PMCID: PMC504855

Orbital exenteration in 95 cases of primary conjunctival malignant melanoma.


The role of orbital exenteration in the management of malignant melanoma of the conjunctiva has been underexplored. The outcome in 95 patients with this condition, who underwent exenteration as a primary treatment (n = 36) or after failure of other treatment (n = 59) for early to advanced stages of the disease, was evaluated. The majority of treated cases had multicentric melanomas sited at prognostically unfavourable locations. In the group of tumours with a maximum thickness of 1.0 mm no melanoma related mortality was noted. Melanomas thicker than 1.0 mm were associated with a mortality varying between 33% and 50%, independent of whether exenteration was performed as primary or secondary treatment. An especially poor outcome was noted for the group of caruncular melanomas despite exenteration. These findings indicate that total eradication of tumour should be performed at an early stage. For this purpose, a combination of debulking surgery and adjunctive cryotherapy or beta radiotherapy is more appropriate than orbital exenteration which causes disfigurement and blindness. Exenteration of the orbit should be reserved as a palliative procedure for advanced stages of neoplastic disease.

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Selected References

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  • Jakobiec FA. Conjunctival melanoma. Arch Ophthalmol. 1980 Aug;98(8):1378–1384. [PubMed]
  • Jakobiec FA, Brownstein S, Wilkinson RD, Khalil M, Cooper WC, Shibata HR. Combined surgery and cryotherapy for diffuse malignant melanoma of the conjunctiva. Arch Ophthalmol. 1980 Aug;98(8):1390–1396. [PubMed]
  • Kennedy RE. Indications and surgical techniques for orbital exenteration. Ophthalmology. 1979 May;86(5):967–973. [PubMed]
  • RENDAHL I. Does exenteratio orbitae improve the prognosis in orbital tumour? Acta Ophthalmol (Copenh) 1954;32(4):431–439. [PubMed]
  • Spaeth EB. Information learned from fifty years of orbital exenteration. Trans Ophthalmol Soc U K. 1971;91:611–634. [PubMed]
  • Rathbun JE, Beard C, Quickert MH. Evaluation of 48 cases of orbital exenteration. Am J Ophthalmol. 1971 Jul 30;72(1):191–199. [PubMed]
  • NAQUIN HA. Exenteration of the orbit. AMA Arch Ophthalmol. 1954 Jun;51(6):850–862. [PubMed]
  • Bartley GB, Garrity JA, Waller RR, Henderson JW, Ilstrup DM. Orbital exenteration at the Mayo Clinic. 1967-1986. Ophthalmology. 1989 Apr;96(4):468–473. [PubMed]
  • Kersten RC, Tse DT, Anderson RL, Blodi FC. The role of orbital exenteration in choroidal melanoma with extrascleral extension. Ophthalmology. 1985 Mar;92(3):436–443. [PubMed]
  • Folberg R, McLean IW, Zimmerman LE. Conjunctival melanosis and melanoma. Ophthalmology. 1984 Jun;91(6):673–678. [PubMed]
  • Folberg R, McLean IW. Primary acquired melanosis and melanoma of the conjunctiva: terminology, classification, and biologic behavior. Hum Pathol. 1986 Jul;17(7):652–654. [PubMed]
  • Paridaens AD, McCartney AC, Lavelle RJ, Hungerford JL. Nasal and orbital recurrence of conjunctival melanoma 21 years after exenteration. Br J Ophthalmol. 1992 Jun;76(6):369–371. [PMC free article] [PubMed]
  • Folberg R, McLean IW, Zimmerman LE. Primary acquired melanosis of the conjunctiva. Hum Pathol. 1985 Feb;16(2):129–135. [PubMed]
  • Folberg R, McLean IW, Zimmerman LE. Malignant melanoma of the conjunctiva. Hum Pathol. 1985 Feb;16(2):136–143. [PubMed]
  • Fuchs U, Kivelä T, Liesto K, Tarkkanen A. Prognosis of conjunctival melanomas in relation to histopathological features. Br J Cancer. 1989 Feb;59(2):261–267. [PubMed]
  • Stefani FH. A prognostic index for patients with malignant melanoma of the conjunctiva. Graefes Arch Clin Exp Ophthalmol. 1986;224(6):580–582. [PubMed]
  • LEDERMAN M. Radiotherapy of malignant melanomata of the eye. Br J Radiol. 1961 Jan;34:21–42. [PubMed]
  • Lommatzsch PK. Beta irradiation of conjunctival melanomas. Trans Ophthalmol Soc U K. 1977 Sep;97(3):378–380. [PubMed]
  • Lommatzsch PK, Lommatzsch RE, Kirsch I, Fuhrmann P. Therapeutic outcome of patients suffering from malignant melanomas of the conjunctiva. Br J Ophthalmol. 1990 Oct;74(10):615–619. [PMC free article] [PubMed]
  • Brownstein S, Jakobiec FA, Wilkinson RD, Lombardo J, Jackson WB. Cryotherapy for precancerous melanosis (atypical melanocytic hyperplasia) of the conjunctiva. Arch Ophthalmol. 1981 Jul;99(7):1224–1231. [PubMed]
  • Jakobiec FA, Rini FJ, Fraunfelder FT, Brownstein S. Cryotherapy for conjunctival primary acquired melanosis and malignant melanoma. Experience with 62 cases. Ophthalmology. 1988 Aug;95(8):1058–1070. [PubMed]
  • Paridaens AD, McCartney AC, Hungerford JL. Multifocal amelanotic conjunctival melanoma and acquired melanosis sine pigmento. Br J Ophthalmol. 1992 Mar;76(3):163–165. [PMC free article] [PubMed]
  • Hykin PG, McCartney AC, Plowman PN, Hungerford JL. Postenucleation orbital radiotherapy for the treatment of malignant melanoma of the choroid with extrascleral extension. Br J Ophthalmol. 1990 Jan;74(1):36–39. [PMC free article] [PubMed]
  • Robertson DM, Hungerford JL, McCartney A. Malignant melanomas of the conjunctiva, nasal cavity, and paranasal sinuses. Am J Ophthalmol. 1989 Oct 15;108(4):440–442. [PubMed]

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