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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

After a classification in benign and malignant tumours and in pigmented and non-pigmented growth, attention is drawn to the fact that most of the tumours lie in the palpebral fissure and are benign. Leukoplakia is a clinical description but not a diagnosis. Both the benign and the malignant growths can be called Leukoplakia. The intra-epithelial epithelioma is often incorrectly diagnosed as Bowen's disease. This disease of the skin and the intraepithelial epithelioma of the limbus are histologically quite different, and therefore the term Bowen's disease is incorrect. Not all the various tumours occur with the same incidence, e. g. the squamous cell carcinoma occurs more often in some countries than in others. The malignant melanomas of the conjunctiva are not so malignant as in the caruncle or cornea. In the conjunctiva secundary melanomas can occur after penetration of an intraocular melanoma through the sclera; similary metastases can occur in the form of epibulbar tumours. In all cases the epibulbar tumour should be excised very carefully and a histological examination is necessary for the diagnosis.
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PMID:[Epibulbar tumours (author's transl)]. 48 Aug 13

Invasive malignant melanoma of the conjunctiva is a rare neoplasm fatal in 40% of cases. Accepted techniques of surgical management include wide local excision, conjunctivectomy, and exenteration. Recently lymphatic dissections have been proposed, but not described, for invasive conjunctival melanoma. We present five cases of invasive conjunctival melanoma, including two with intraglandular parotid metastases. The surgical management of these patients is presented, and a proposal is made for radical bloc dissection of the orbital contents and regional lymphatics. The histology of conjunctival melanoma is discussed, and a classification proposed to assist the head and neck surgical team in the management of this disease.
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PMID:Malignant melanoma of conjunctiva metastatic to parotid gland. Reports of cases and discussion of surgical management. 92 64

203 cancers of the eyelid were operated on in 193 patients. 65% of the tumours occurred in males and the peak incidence was at 75 years. 60% afflicted the lower eyelids and 21% the medial canthi. Basal cell carcinoma were found in 182 specimens and spinocellular carcinoma in only 8. Malignant melanoma, Meibomian gland carcinoma and rhabdomyosarcoma appeared each in one patient, the latter representing the only fatal case in eyelid cancer. All cancers were excised with a free margin around 5 mm. The standard procedures of reconstruction of the eyelid defect were a fullthickness skin graft in cases where conjunctiva and tarsus could be preserved (97 cases), and a tarsoconjunctival flap in full-thickness defects of the lower eyelid (58 cases). Other methods used were wedge excision and direct approximation in very small lesions involving the lid margin, an infratarsal island flap from the lower eyelid for medium-sized to large defects in the upper lid and a forehead or scalp flap after exenteration of the orbit. 18/203 cancers recurred and 12 of these were primarily regarded as radically treated. Seven of the latter were reoperated after more than 3 years and may in fact be new tumours. No metastases were found. The various reconstructive procedures are discussed in detail
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PMID:Surgical treatment of eyelid cancer with special reference to tarsoconjunctival flaps. A follow-up on 193 patients. 110 77

The authors present the results of clinical and morphologic analysis of 10 cases with annular iridociliary tumors that occurred within the latest decade. The incidence of this tumor among other intraocular tumors has been 3.7%, that among iridocialiary tumors, 42.8%. In seven of the ten patients the disease manifested by elevation of intraocular pressure, less frequently it manifested by changed color of the iris or acute iridocyclitis. Extrabulbar tumor growth into the scleral conjunctiva was observed in half of the patients, in two of these lymphogenic metastases were detected. The prolonged latent course of the disease impeded in the majority of cases not only timely diagnosis of the intraocular tumor, but of its dissemination as well. Four histologic variants of the tumor growth were distinguished.
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PMID:[The clinico-morphological characteristics of the annular form of iridociliary neoplasms]. 129 95

A 50-year-old white man complained of "inflammation" of his right eyelid since January 1989. In June 1990, he had undergone a gastrectomy for an adenocarcinoma of the stomach. In August 1990, his right eye showed a painless, firm infiltration of the upper and lower lid, ulceration and loss of eyelashes of the upper lid and a reddish, subepithelial thickening of the medial bulbar conjunctiva. Biopsies of the right upper lid and nasal bulbar conjunctiva disclosed a metastatic, poorly differentiated adenocarcinoma of the stomach (signet ring cell carcinoma) both in the lid and conjunctival biopsies. Carcinoembryonic antigen (CEA) was detected in the tumor cells. Electron microscopic examination revealed tumor cells with signs of secretory activity. Although metastases to the eyelids and conjunctiva are rare, they may precede the clinical manifestation of the primary tumor for months or even years. In patients with chronic, recalcitrant lesions of eyelids or conjunctiva, especially if accompanied by loss of eyelashes, a primary or secondary malignancy should be excluded by early biopsies and histopathological examination.
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PMID:Gastric adenocarcinoma presenting as an eyelid and conjunctival mass. 132 10

We report on a 76-year-old patient with a squamous cell carcinoma of the left orbit. The tumour had no connection with the conjunctiva but was located at the site of an encircling band which had been inserted 13 years before. A major part of the tumour presented as a well circumscribed solid mass within the extraocular tissues next to the inferior equator, but the exenteration specimen also showed tumour extension within the adjacent choroid. Histological examination showed a well differentiated keratinising squamous cell carcinoma with numerous mitotic figures and many epithelial pearls. A thorough examination in search of a primary carcinoma of the lacrimal gland or the sinus, with invasion into the orbit, or an epithelial neoplasm elsewhere suggestive of metastatic disease into the choroid did not reveal any specific pathological findings. Thus the most probable origin of the tumour seems to be epithelium which had been misplaced during retinal detachment surgery and had subsequently undergone malignant transformation.
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PMID:Orbital squamous cell carcinoma after retinal detachment surgery. 191 65

This essay places the concept of "primary acquired melanosis" of the conjunctiva in historical perspective and shows that it and its analogs, namely, lentigo-melanosis (Hutchinson), melanotic freckle (Hutchinson), melanose circonscrite precancereuse (Dubrueilh), melanotische precancerose (Miescher), lentigo maligna (Clark), precancerous melanosis (Reese), benign, precancerous, and cancerous melanosis (Zimmerman), atypical melanocytic hyperplasia (Silver et al.), and benign acquired melanosis (Zimmerman), are synonyms for melanoma in situ. The issue is not merely semantic or philosophical; it is urgently practical. If a clinician takes literally the meaning of a lesion designated "benign melanosis" and considers it to be benign, rather than the malignant melanoma that it actually is, a patient who bears that flat pigmented lesion may one day die of metastasis from an elevated sequella of it. The same is true of "primary acquired melanosis," which is not simply a condition of blackening by melanin, but a flat melanoma that, if not removed completely, may give rise one day to metastases that cause death. To avoid such misconstructions, we advocate naming melanomas in all organs "melanoma" and those that are confined to epithelial structures "melanoma in situ." Euphemisms like lentigo maligna and primary acquired melanosis are evasions of the diagnosis of melanoma, and use of them may be harmful. For that reason, they should be eschewed.
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PMID:Primary acquired melanosis of the conjunctiva is melanoma in situ. 149 53

Eighty-one cases of conjunctival melanoma treated between 1960 and 1988 were studied to determine factors that might affect outcome in patients with such lesions. The therapeutic procedures performed were local excision (16), local excision followed by brachytherapy with Sr-90/Y-90 (32), local excision followed by cryotherapy with liquid nitrogen (16), brachytherapy with Sr-90/Y-90 (12), local excision followed by external beam irradiation (3), and local excision followed by brachytherapy and cryotherapy (2). The median follow-up period was 5.5 years (longest 26, shortest 1 year). Sixty two patients (76.5%) showed a complete regression of the melanoma, 19 (23.5%) developed recurrences, and 15 (18.5%) died from metastases. The melanomas had developed with almost equal frequency from a pre-existing naevus (25.9%), from primary acquired melanosis (25.9%), and 'de novo' (30.9%). Small tumours had a higher chance of regressing (80.6%) than larger ones (68.6%). The cumulative survival rate was 76% after five years and 60% after 10 years from any causes of death and 87.6% after five years and 76.3% after 10 years from deaths caused by metastases. Most deaths from metastases occurred within 5 years. At 88.5%, the cumulative survival rate of patients with small tumours (less than one quadrant of the bulbar conjunctiva and less than 2 mm thickness) was significantly higher than that of patients with larger tumours (more than one quadrant of the bulbar conjunctiva and/or more than 2 mm thickness) with 65% after eight years. Local excision followed by beta ray irradiation (Sr-90/Y-90) or cryotherapy can be recommended as the treatment of choice. Nevertheless the behaviour of conjunctival melanomas remains unpredictable in individual cases.
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PMID:Therapeutic outcome of patients suffering from malignant melanomas of the conjunctiva. 228 86

A large number of cases of ocular melanoma have been entered in The Provincial Cancer Registry of Alberta over the past 40 years. This study was undertaken in order to describe further the natural history of this disease and derive management recommendations for use at the provincial level. A retrospective chart review was carried out on all cases of ocular melanoma registered through The Alberta Provincial Cancer Registry between 1949 and 1987. Two hundred fifty-one cases were identified: 143 were males and 108 were females. The mean age of the patients at diagnosis was 60. The majority of the melanomas arose from the choroid of the eye (82%) with the remainder arising from the iris, conjunctiva and ciliary body, respectively. According to the Callender classification for ocular melanomas, the majority of the melanomas were of the spindle cell type (53%), the others being either mixed cell (23%), epithelioid (8%), or fascicular (1%). Survival rates differed depending on the cell type. Spindle cell tumors demonstrated a mean survival time of 5.2 years; epithelioid tumors 4.8 years and the mixed cell tumors appeared to be the most aggressive with a mean survival time of 2.7 years after diagnosis. The majority of deaths from ocular melanoma occurred within 5 years of diagnosis, although 14% of patients in this review presented with metastases more than 10 years after diagnosis. Some of the cases of ocular melanoma could be classified pathologically as small, medium, or large. Patients with large ocular melanomas had a 5 year survival rate of 33% compared to 70% and 66% for patients with small and medium sized tumors. Of note, 43% of patients with large ocular melanomas who were dead from their disease within 5 years of diagnosis were also found to have mixed cell tumors. These findings call for a longer follow-up period for ocular melanomas and point to the importance of cell type and tumor size as predictors of survival and as guides in planning prophylactic therapeutic interventions.
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PMID:Ocular melanoma in Alberta: a 38 year review pointing to the importance of tumor size and tumor histology as predictors of survival. 259 63

Twenty-six patients (age 29-85 years) with primary malignant melanoma of the conjunctiva were analysed for usefulness of various histopathological and immunohistochemical features of the primary, recurrent and metastatic tumours in evaluating their prognosis. The mean follow-up time was 5.5 years, ranging from 8 months to 17 years. Eight patients developed metastases and seven have died. The mean time from diagnosis to death due to metastasis was 3.8 years (range 1-6 years). The site of the primary tumour seemed to be most closely correlated to high metastatic risk. Only two of the sixteen limbal melanomas metastasised, whereas two of the four bulbar, all three tarsal and the only diffuse primary tumour caused metastatic disease. Two of the metastasising primary tumours were less than 1.5 mm thick, but all exceeded 0.8 mm in thickness. The mitotic rate, the amount of inflammatory infiltrate, the cell type or the presence of adjacent intraepithelial involvement did not obviously correlate to treatment outcome. Furthermore, the expression of S-100 protein and neuron-specific enolase (NSE), both suggested to be prognostic indicators in cutaneous melanoma, did not correlate to the tendency of the conjunctival melanomas to recur or metastasise.
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PMID:Prognosis of conjunctival melanomas in relation to histopathological features. 264 32


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