Epistaxis or Epiphora as sign for extension of a conjunctival melanoma. A series of six patients with nasolacrimal recurrence.
Résumé
ABSTRACT Purpose: to characterize malignant conjunctival melanomas with extension and recurrence in the nasolacrimal system. Methods: localization of the primary tumor and recurrences of 210 conjunctival melanomas treated in the Netherlands were reviewed for orbital and nasal tumors (1978-2008). On the basis of these cases and literature data, characteristics for nasolacrimal system extension and metastasis were reviewed. Results: Six patients (3%) showed a recurrence of the primary conjunctival melanoma in the nasolacrimal system. Two of the six primary tumors were limbal tumors, the other four were diffuse tumors involving the fornix. In all six patients, the primary conjunctival melanomas were associated with primary acquired melanosis (PAM). During follow-up period (mean 11.6 ± 3 years; median 8.7 years) two patients developed metastases, and died during follow-up. Conclusions: Patients should be advised to contact the treating ophthalmologist in the case of symptoms of epiphora, nose obstructions and epistaxis, especially non-bulbar and diffuse cases associated with PAM.
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