In a follow-up study of 45 conjunctival melanoma patients the recurrence rate after local excision was 80% but the mortality rate due to metastasis was low, only 2 out of 25 cases in which the recurrences could be controlled by repeated local excisions. In the 18 cases in which exenteration was required, because of the unfavourable localization of the melanoma or repeated recurrences, the mortality rate due to metastatic disease (7 out of 18) was high.
Conjunctival melanomas, rightly described by Jakobiec (1980) as an unfinished business, present a large number of unsolved problems. They may develop either de novo, in a benign conjunctival naevus, or in acquired melanosis. The mortality in conjunctival malignant melanoma is high (14-42%) as is its recurrence rate after local excision (72-88%) (Liesegang and Campbell, 1980;Crawford, 1980). However, follow-up studies of large numbers of patients are few, because conjunctival melanoma is a rare tumour. Therefore, a study group on conjunctival melanoma has been formed on the initiative of Manschot in order to collect all the follow-up data ofconjunctival melanoma patients in the Netherlands from 1960 to the present day. Through the cooperation of all eye clinics and of ophthalmologists we have collected full follow-up data of 45 patients. The following two case histories, the first with recurrent melanoma in acquired melanosis, the second with a large solitary tumour in the fornix, show that conjunctival melanomas are a potentially fatal disease.
Case history nr. 1
A 65-year-old man visited his ophthalmologist in 1967 with areas of flat pigmentation which had grown in the course of several years, located in the conjunctiva of his right eye. In the five subsequent years the pigmentation varied in localization and intensity. In 1972 the pigmentations had reached the margins of the eyelids and an unpigmented mass was present near the limbus at the 8 o'clock position (Figure 1). This tumour was excised locally.