Topical mitomycin-C chemotherapy for conjunctival melanoma

Background: We have shown that the use of topical mitomycin-C (MMC) induced tumor regression with minimal toxicity in a case of conjunctival melanoma (BJO 1993;77:751-753). Encouraged by this result we have used topical MMC as either primary or adjuvant therapy in 8 cases of conjunctival melanoma. Purpose: A study of primary and adjuvant topical MMC chemotherapy in the treatment of conjunctival melanoma. Methods: Two patients were offered topical MMC (0.04% - Q.I.D. x 28 days) chemotherapy as a curative treatment for their conjunctival melanomas. Six additional patients were given adjuvant topical MMC (0.04% - Q.I.D. x 7 days) chemotherapy after excision and cryotherapy in an effort to prevent treat subclinical disease and prevent recurrence. Results: Clinical examinations revealed acute transient conjunctivitis and keratitis for up to 60 days after treatment. One corneal abrasion (Pt. 1) and opacity (Pt. 2) were noted. No observable scleral damage was present in any patient. Evidence of tumor regression was noted in both patients treated for 28 days. Patient 1 was noted to have residual disease and eventually required exenteration. Patient 2 has had no evidence of recurrence at 24 mos. The remaining 6 patients have exhibited no long-term toxicity or evidence of recurrence after a mean of 19 months (range 5-35). One patient (Pt. 1) has developed metastatic disease, none as yet have died. Conclusion: We have used topical mitomycin-C chemotherapy to treat 8 patients with conjunctival melanoma. This method provides a non-surgical treatment for an entire conjunctiva at risk for recurrent tumor formation. Further study of topical chemotherapy for conjunctival neoplasia is warranted.