Меланома века.

dok_zlo — 01.04.2022

Melanoma of the Palpebral Conjunctiva and Eyelid
A 47-year-old woman presented to the ophthalmology clinic with a 2-week history of eyelid itching and the sensation of a foreign body in the right eye. Examination showed a raised, pigmented area with ill-defined margins protruding from the right upper eyelid (Panel A). Eyelid eversion revealed a large, poorly delineated, pigmented lesion on the right palpebral conjunctiva (Panel B). An excisional biopsy was performed, and pathological analysis showed infiltration of epithelioid and spindle-shaped melanocytes to a depth of 1.8 mm. Immunohistochemical staining was positive for HMB-45, SOX10, and PRAME (preferentially expressed antigen of melanoma). A diagnosis of malignant melanoma of the palpebral conjunctiva, with local invasion of the eyelid, was made. No mutations in BRAF were detected, and no regional lymph-node or distant metastases were observed on evaluation of the cancer stage. Conjunctival melanomas account for a minority of ocular melanomas, most of which arise from the uveal tract. The patient declined surgical excision and underwent treatment with pembrolizumab. At follow-up, which at the time of publication had occurred monthly since the diagnosis was made in August 2021, the lesion had not expanded.

Peng Zhang, M.D., Ph.D., and Lian Chen, M.D. March 24, 2022 N Engl J Med 2022; 386:e28

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