Conjunctival Melanoma Treated with Systemic Checkpoint Inhibitors

A patient with past medical history of basal cell carcinoma and metastatic scalp melanoma presents with an enlarging pigmented lesion of his left conjunctiva. His vision was intact in both eyes with normal intraocular pressures. Examination demonstrated an irregular pigmented lesion at the limbus extending from 1 to 4 o clock. Anterior segment OCT revealed a thickened hyperreflective subepithelial mass sitting below an area of full thickness epithelial hyperreflectivity without thickening. This was consistent with a PAM lesion and associated conjunctival melanoma. The patient declined surgical intervention as he was pending immunotherapy with checkpoint inhibitors. On follow up, the patient’s pigmented lesion had essentially resolved, after two cycles of immunotherapy with checkpoint inhibitors. The traditional management of conjunctival melanomas is to excise the tumor as soon as possible. Several case reports have been published showing the efficacy of checkpoint inhibitors in the adjuvant management of advanced local and metastatic conjunctival melanoma. Checkpoint inhibitors are antibodies that help to activate the body’s immune system to kill a tumor. Studies on cutaneous melanoma suggest that the use of checkpoint inhibitors neoadjuvantly may improve mortality and outcomes for patients, as opposed to immediately excising the tumor and using chemotherapy adjuvantly. There is a new study launching at Bascom Palmer to investigate the use of neoadjuvant checkpoint inhibitors in patients with conjunctival melanoma to determine if it may improve outcomes for these patients.

Presentation Date: 08/01/2024

Issue Date: 08/16/2024