Conjunctival Primary Acquired Melanosis with Periocular Lentigo Maligna: 19-year Outcomes at a London Tertiary Referral Centre
Author: Mumta Kanda
Base Hospital / Institution: Moorfield’s Eye Hospital, London
ePoster presentation
Abstract ID: 24-208
Purpose
There is paucity of studies about the clinical features and outcomes of primary acquired melanosis (PAM) with spillover periocular lentigo maligna (LM). We aimed to evaluate these challenging cases at a London tertiary referral centre.
Methods
A retrospective consecutive case review was conducted of patients with PAM with LM over a 19-year period between January 2005 to April 2024.
Results
21 patients (62% female, 100% caucasian) were included. Average age at diagnosis was 67 (40-89). Average length of follow-up was 11 (1-32) years. 16 (76%) patients developed melanoma (including 7 who presented with melanoma within PAM with LM): 11 conjunctival (CoM), 1 lentigo maligna (LMM), 3 superficial spreading (SSM), and 1 SSM and CoM at different times. Of those with melanoma, 13 (81%) had PAM with severe atypia, 1 (6%) had moderate atypia, and 1 (6%) had mild atypia (1 had atypia of unknown severity). Average time between PAM/LM to melanoma diagnosis was 72 (0-288) months. Management of PAM with LM included observation, surgery with slow Mohs and excisional biopsy, and non-surgical treatment (usually adjuvant) with cryotherapy, mitomycin C (MMC), and interferon-alpha 2b. Primary management of melanoma was surgery with slow Mohs, wide-local excision, excisional biopsy, or exenteration, and adjuvant treatment with cryotherapy, MMC, interferon, and strontium radiotherapy. 7 (44%) patients had melanoma recurrence: 5 (71%) in CoM, 2 (29%) in SSM. 6 (86%) of these had PAM with severe atypia. 4 patients (all CoM) had metastases and 100% of these had PAM with severe atypia. Systemic treatment for metastases included pembrolizumab (1), pembrolizumab/ipilimumab/chemotherapy (1), and stereotactic radiotherapy (1). 4 patients died, including 2 from metastatic melanoma. 4 (20%) patients were disease-free at the end of study period.
Conclusion
PAM with overspill LM, especially with severe atypia, is associated with poorer outcomes, including higher risk of melanoma, recurrent disease and metastases. Early and more aggressive management and lifelong monitoring is recommended.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Allan | Nghiem | Moorfield’s Eye Hospital, London |
| Tarang | Gupta | Moorfield’s Eye Hospital, London |
| Claire | Daniel | Moorfield’s Eye Hospital, London |
