Surgical management of conjunctival melanomas.

I t has been proposed that ocular surface melanomas should be treated by simple local excision and cryotherapy to the conjunctival borders. Based on what is known of the biology of both cutaneous and mucosal melanomas, however, we consider it unlikely that such a technique, without deep scleral clearance, will reliably eliminate ocular surface melanomas. Indeed, the documented behavior of melanomas on other areas of the body is contradictory to this possibility. As with other melanomas, avoiding local recurrence of conjunctival melanomas by excising the tumor with adequately wide margins is clearly of critical importance because it has previously been shown by the same authors that local recurrence of conjunctival melanoma is associated with a markedly increased rate of distant metastasis. We are very concerned that the results of the conservative excision techniques described by Shields et al have not been reported and believe that more radical excision techniques should not be abandoned unless these results are made available and demonstrate at least equivalent efficacy. Until we understand more about the biology of melanoma in general and ocular surface melanoma in particular, we consider that hard data are required to show that simple local methods of excision are satisfactory for preventing local recurrence and curing the patient as well as for preserving vision.