Primary acquired melanosis with spill over periocular lentigo maligna: 19-year outcomes at a specialist eyelid and ocular oncology centre.

IF 3.7 2区 医学 Q1 OPHTHALMOLOGY
Mumta Kanda, Allan Zhifa Nghiem, Fariha Shafi, Shirin Hamed Azzam, Tarang Gupta, Claire Daniel
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Abstract

Background/aims: There is a paucity in the literature on the presentation, management and outcomes of cases where primary acquired melanosis (PAM) is associated with spill over/contiguous periocular lentigo maligna (LM). We describe experience of such cases at our eyelid and ocular oncology specialist centre.

Methods: We conducted a retrospective consecutive case review of adult patients with PAM and periocular LM between 2005 and 2024 at Moorfields Eye Hospital in London. Demographic data, diagnosis, histology, imaging, treatment, surgical notes, outcomes and follow-up were collected from the electronic patient record.

Results: Of 21 patients identified, 100% were Caucasian, 13 (62%) were women and the average age of diagnosis was 67 years. Grade of PAM atypia was mild in 5 (24%), moderate in 2 (9%) and severe in 14 (67%) patients. 16 (76%) patients developed melanoma (all types) and 12 (57%) patients developed conjunctival melanoma. Of those with PAM with severe atypia, 93% developed melanoma. The average time interval from diagnosis of PAM and LM to melanoma was 72 months. Melanoma recurrence occurred in 7 (44%) and metastases developed in 4 (25%) patients. Four patients died, including two from metastatic melanoma. Average follow-up length was 129 months.

Conclusions: PAM with atypia, particularly severe atypia, when associated with spill over periocular LM, may have significant risk of progression to melanoma. Patients with PAM require careful eyelid examination to identify LM. Management requires multidisciplinary input, urgent biopsy and confocal microscopy if available, lower threshold for treatment and lifelong monitoring.

原发性获得性黑素病伴溢过眼周恶性晶状体:专科眼睑和眼部肿瘤中心19年的结果。
背景/目的:关于原发性获得性黑素病(PAM)与外溢性/连续性眼周恶性晶状体(LM)相关病例的表现、处理和结果的文献很少。我们描述的经验,这样的情况下,我们的眼睑和眼部肿瘤专科中心。方法:我们对2005年至2024年间伦敦Moorfields眼科医院的PAM和眼周LM的成人患者进行了回顾性的连续病例回顾。统计资料、诊断、组织学、影像学、治疗、手术记录、结果和随访从电子病历中收集。结果:21例确诊患者中,100%为白种人,13例(62%)为女性,平均诊断年龄为67岁。轻度5例(24%),中度2例(9%),重度14例(67%)。16例(76%)患者发展为黑色素瘤(所有类型),12例(57%)患者发展为结膜黑色素瘤。在患有严重异型性PAM的患者中,93%发展为黑色素瘤。从PAM和LM诊断到黑色素瘤的平均时间间隔为72个月。黑色素瘤复发7例(44%),转移4例(25%)。四名患者死亡,其中两名死于转移性黑色素瘤。平均随访时间为129个月。结论:非典型性的PAM,特别是严重的非典型性,当伴有眼周LM溢出时,可能有进展为黑色素瘤的显著风险。PAM患者需要仔细检查眼睑以确定LM。管理需要多学科的投入,紧急活检和共聚焦显微镜(如果有的话),较低的治疗门槛和终身监测。
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来源期刊
CiteScore
10.30
自引率
2.40%
发文量
213
审稿时长
3-6 weeks
期刊介绍: The British Journal of Ophthalmology (BJO) is an international peer-reviewed journal for ophthalmologists and visual science specialists. BJO publishes clinical investigations, clinical observations, and clinically relevant laboratory investigations related to ophthalmology. It also provides major reviews and also publishes manuscripts covering regional issues in a global context.
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