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Conjunctival melanoma: is it increasing in the United States?

https://arctichealth.org/en/permalink/ahliterature182592
Source
Am J Ophthalmol. 2003 Dec;136(6):1189-90; author reply 1190
Publication Type
Article
Date
Dec-2003
Author
Seppo Tuomaala
Tero Kivelä
Source
Am J Ophthalmol. 2003 Dec;136(6):1189-90; author reply 1190
Date
Dec-2003
Language
English
Publication Type
Article
Keywords
Conjunctival Neoplasms - epidemiology
Finland - epidemiology
Humans
Incidence
Melanoma - epidemiology
Sex Distribution
United States - epidemiology
Notes
Comment On: Am J Ophthalmol. 2003 Jun;135(6):800-612788119
PubMed ID
14644247 View in PubMed
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Metastatic pattern and survival in disseminated conjunctival melanoma: implications for sentinel lymph node biopsy.

https://arctichealth.org/en/permalink/ahliterature180897
Source
Ophthalmology. 2004 Apr;111(4):816-21
Publication Type
Article
Date
Apr-2004
Author
Seppo Tuomaala
Tero Kivelä
Author Affiliation
Ocular Oncology Service, Department of Ophthalmology, Helsinki University Central Hospital, Haartmaninkatu 4C, PL 220, FIN-00029 HUS, Helsinki, Finland. seppo.tuomaala@hus.fi
Source
Ophthalmology. 2004 Apr;111(4):816-21
Date
Apr-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Conjunctival Neoplasms - mortality - pathology - surgery
Cross-Sectional Studies
Female
Finland - epidemiology
Humans
Incidence
Lymph Nodes - pathology
Lymphatic Metastasis
Male
Melanoma - mortality - secondary - surgery
Middle Aged
Prognosis
Retrospective Studies
Sentinel Lymph Node Biopsy
Survival Rate
Time Factors
Abstract
To study the pattern of metastasis and overall survival in patients with disseminated conjunctival melanoma.
Population-based, retrospective cross-sectional study.
Eighty-five Caucasian patients with primary malignant conjunctival melanoma diagnosed between 1967 and 2000.
Data were collected from the Finnish Cancer and Population Registries and all involved hospitals. The pattern (regional or systemic) and site of first metastasis were recorded. The time to first metastasis and survival by pattern were estimated by cumulative incidence analysis, which takes competing risks into account, and by Kaplan-Meier analysis, respectively.
Metastatic pattern, time to metastasis by pattern, overall survival.
In 45% (95% confidence interval, 23%-68%) of 20 patients with metastasis, regional lymph node metastases were detected before systemic ones. Median times to initial regional and systemic metastasis were 2.3 and 3.4 years, respectively, and the median time from regional to systemic metastasis, 1.0 year. The 10-year cumulative incidence of initial regional metastasis was 0.11, and it tended to be higher for tumors more than 2 mm thick (0.18 vs. 0.05, P = 0.062). The corresponding incidence of initial systemic metastasis was 0.18, and it was higher for nonlimbal tumors (0.38 vs. 0.07, P = 0.00023) and for tumors more than 2 mm thick (0.28 vs. 0.06, P = 0.026). Overall survival was longer after initial regional metastasis than after systemic metastasis (30 vs. 8 months, P = 0.012).
Initial regional lymph node metastasis was as common as systemic metastasis, but initial lymph node metastasis was associated with better prognosis. Metastasis, especially initial regional lymph node metastasis, from limbal tumors and tumors less than 2 mm thick was rare. These patients may have less benefit from sentinel lymph node biopsy, a method that is currently under evaluation regarding its potential to improve survival.
Notes
Comment In: Ophthalmology. 2004 Dec;111(12):2317; author reply 2317-815582101
PubMed ID
15051218 View in PubMed
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Population-based assessment of clinical characteristics predicting outcome of conjunctival melanoma in whites.

https://arctichealth.org/en/permalink/ahliterature187954
Source
Invest Ophthalmol Vis Sci. 2002 Nov;43(11):3399-408
Publication Type
Article
Date
Nov-2002
Author
Seppo Tuomaala
Sebastian Eskelin
Ahti Tarkkanen
Tero Kivelä
Author Affiliation
Ocular Oncology Service, Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland. seppo.tuomaala@hus.fi
Source
Invest Ophthalmol Vis Sci. 2002 Nov;43(11):3399-408
Date
Nov-2002
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Aged, 80 and over
Conjunctival Neoplasms - ethnology - mortality - surgery
European Continental Ancestry Group
Female
Finland - epidemiology
Humans
Incidence
Male
Melanoma - ethnology - mortality - surgery
Middle Aged
Neoplasm Recurrence, Local - ethnology - mortality - surgery
Prognosis
Sex Distribution
Survival Rate
Abstract
To identify the clinical determinants of prognosis and the incidence of malignant conjunctival melanoma in whites.
A nationwide search identified 85 patients in whom primary conjunctival melanoma was diagnosed in Finland between 1967 and 2000, all of whom were enrolled. Data were collected from the Finnish Cancer and Population Registries and from patients' charts in all involved hospitals. The age-specific and age-adjusted incidences were calculated. Clinical characteristics of the tumors were recorded and time to local recurrence and melanoma-specific survival were analyzed by Kaplan-Meier analysis and univariate and multivariate extended Cox regression.
The annual crude incidence of conjunctival melanoma in Finland was 0.51 per million inhabitants, and the age-adjusted incidence (mean, 0.54) increased from 0.4 to 0.8 during the 34-year study period. The median age at diagnosis was 60 years (range, 20-90). Clinically detectable primary acquired melanosis preceded or accompanied the primary tumor in 61% of patients. The 5-year cumulative proportion of cases with local recurrence was 0.36 (95% confidence interval [CI], 0.25-0.48). The melanoma-specific 5-and 10-year mortalities were 0.20 (95% CI, 0.12-0.32) and 0.38 (95% CI, 0.26-0.53), respectively. By multiple-event Cox regression, nonlimbal location of the primary tumor predicted a short time to local recurrence (hazard ratio [HR] 1.81, P = 0.024). Nonlimbal location of the primary tumor (HR 4.08, P = 0.023) and increasing tumor thickness (HR 1.19 for each millimeter change, P=0.063) were associated with increased mortality. Local recurrence, analyzed as a time-dependent covariate, also increased mortality (HR 1.39 for each recurrence, P = 0.014).
The incidence of conjunctival melanoma in the white population of Finland increased analogous to cutaneous melanoma. Nonlimbal tumors recur more often and are associated with decreased survival, independent of their greater thickness. Local recurrence contributes to mortality, whereas primary acquired melanosis was not associated with either outcome.
PubMed ID
12407149 View in PubMed
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Prognostic significance of histopathology of primary conjunctival melanoma in Caucasians.

https://arctichealth.org/en/permalink/ahliterature160240
Source
Curr Eye Res. 2007 Nov;32(11):939-52
Publication Type
Article
Date
Nov-2007
Author
Seppo Tuomaala
Päivi Toivonen
Ranaa Al-Jamal
Tero Kivelä
Author Affiliation
Ocular Oncology Service, Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland. seppo.tuomaala@hus.fi
Source
Curr Eye Res. 2007 Nov;32(11):939-52
Date
Nov-2007
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cell Nucleolus - pathology
Conjunctival Neoplasms - mortality - pathology
European Continental Ancestry Group
Female
Finland - epidemiology
Humans
Lymphocytes, Tumor-Infiltrating - pathology
Macrophages - pathology
Male
Melanoma - mortality - pathology
Middle Aged
Mitotic Index
Neoplasm Recurrence, Local - pathology
Prognosis
Survival Rate
Abstract
To assess histopathologic prognostic factors relative to clinical ones in predicting local recurrence and survival after primary conjunctival melanoma (CM).
85 patients with CM were identified in Finland between 1967 and 2000, and 70 primary tumors were available for histopathologic study. Time to first recurrence and melanoma-related mortality were analyzed.
Absence of epithelioid cells (P=0.033), smaller mean diameter of the ten largest nucleoli (P=0.041) and increasing mitotic count (P=0.042) were associated with shorter time to recurrence. The mean diameter of the ten largest nucleoli, the number of tumor-infiltrating lymphocytes and macrophages, extravascular matrix loops and networks, and microvascular density were unassociated with recurrence. Nonlimbal location (P=0.001), recurrence (P
PubMed ID
18027170 View in PubMed
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