| 나현민(1,3), 정호경(1,2), 최혁진(1,3), 김남주(1,4), 곽상인(1,3) |
| 본문 : Conjunctival malignant melanoma is a rare ocular tumor that can not only spread to other organs by distance metastasis but also recur even after margin-free excision. Here we report a case of recurrence of conjunctival melanoma presented as bloody epiphora.
A 51-year-old female presented with a painless brownish pigmented mass in the left conjunctiva. After incisional biopsy which turned out to be conjunctival malignant melanoma, we performed wide excision of the mass from both upper and lower lid with frozen control followed by cryotherapy, 270-degree bulbar conjunctiva and corneal limbus. For limbal invasion we performed lamellar keratectomy simultaneously. For the defective sites, we transplanted two separate amniotic membranes. Four years after the surgery, she came to the clinic with bloody discharge form the left lower punctum. Considering that bloody discharge at punctum is itself a strong sign of abnormality, we strongly recommended her prompt work up and treatment. However, she refused the imaging for several years because of rare intermittency of the bloody discharge until when she finally got magnetic resonance imaging which revealed a mass, extending to left nasal cavity, inferior turbinate, inferior meatus, middle meatus, nasolacrimal duct, nasolacrimal sac, left medial preseptal space and conjunctiva. For this extensive mass, excision was done including uncinectomy, ethmoid bullectomy, inferior turbinectomy, dacryocystectomy, with medical canthal tissue excision including upper and lower canaliculi both externally and endoscopically with otorhinolaryngology specialist. The pathologic exam showed cancer cell involvement at lacrimal sac, but punctum and both canaliculi were free of tumor cell. Bloody epiphora or nasal bleeding may imply possible metastasis to nasolacrimal drainage system. In such case, we recommend prompt workup in an effort to detect signs of metastasis and timely treatment. |