Prognosis and determinants of survival after orbital exenteration for conjunctival melanoma: experiences from a Dutch Referral Centre

Abstract

PurposeTo assess the prognosis and determinants of survival after orbital exenteration in patients with conjunctival melanoma (CoM).MethodsIn a retrospective study, 27 consecutive patients who underwent exenteration for CoM from 2001 to 2023 were included. Overall survival (OS), progression-free survival (PFS) and their risk factors were analysed.ResultsThe mean follow-up time since orbital exenteration was 42 +/- 37 months. Eyelid sparing orbital exenteration was achieved in 24 patients (89%). Two patients (7%) developed local recurrences. Seven patients (26%) developed distant metastasis resulting in a metastasis-free survival of 100% at 1 year and 63% at 5 years. The PFS was 100% and 63% at 1 and 5 years, respectively. The OS for 1, 5 and 10 years was 92, 57 and 31%, respectively. Presence of recurrences prior to exenteration and longer time from diagnosis to exenteration were related to worse OS (both p = 0.02). Presence of metastasis prior to exenteration, orbital invasion and tumour-containing resection margins were related to a worse PFS at 5 years (p = 0.03, p = 0.03 and p = 0.02, respectively).ConclusionFor CoM patients treated with orbital exenteration, the presence of metastases and recurrences prior to exenteration, longer time from diagnosis to exenteration, orbital invasion and tumour-containing resection margins are unfavourable prognostic factors. Our study demonstrates relatively favourable outcomes, with no difference in survival between eyelid sparing or eyelid removing techniques, calling to consider orbital exenteration for advanced CoM cases when other (newer) therapies are not applicable.