Internal Medicine

0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54

Conjunctival Tumors 393

Conjunctival Tumors..................................

DEVRON H. CHAR, MD

history & physical

■Conjunctival tumors are rare; most common in elderly, sun-exposed

patients.

■Older patients with a unilateral, chronic inflammation of conjunctiva

and/or eyelid

■Malignancy should be ruled out histologically.

tests

■All suspicious lesions should be biopsied.

differential diagnosis

■Most common conjunctival tumors: squamous cell carcinoma,

melanoma, benign and malignant lymphoid lesions and KS.

management

■Management of both squamous cell carcinoma and melanoma usu-

ally is surgical.

■Flat, in situ lesions may be treated with topical anti-metabolites.

■Resection with clear margins: <2% recurrences; >60% if partially

removed

■In American patients only two reports of metastases in conjunctival

squamous cell carcinoma

■Lymphoid lesions; conventional histologic lymphoma work-up

■Flow cytometry & molecular studies to differentiate benign/

malignant lymphoid lesions

■Symptomatic isolated conjunctival lymphoid lesion usually irradia-

ted; preliminary results with doxycycline forChlamydia psittaci

■Conjunctival lymphoma with systemic disease: chemotherapy

specific therapy

n/a

follow-up

■Conjunctival melanomas spread (risk factors: thicker tumors, more

diffuse lesions, involvement of the caruncle or eyelid) to lymph

nodes, lung and liver.

■Lymphoid conjunctiva lesions rarely develop extraocular disease;

those that also involve the orbit can have or develop widespread

lymphoma.