Resolución de un melanoma conjuntival con interferón tópico alfa 2b en un paciente con intolerancia a la mitomicina C / Resolution of conjunctival melanoma with topical interferon alpha 2 b in a patient with mitomycin C intolerance

OBJETIVO: Describir la resolución clínica e histológica de un caso de melanoma conjuntival irresecable con interferón tópico alfa 2b (INF-alfa-2b) en un paciente con intolerancia a la mitomicina C (MMC). CASO CLÍNICO: El melanoma conjuntival es un tumor raro pero potencialmente peligroso para la función visual y la vida del paciente. En caso de lesiones múltiples o cuando no es posible la escisión quirúrgica, se ha descrito la quimioterapia con combinación tópica de MMC e INF-alfa2b como terapia de primera línea. Comunicamos el caso de una mujer de 77 años con melanoma in situ conjuntival multifocal que mostró intolerancia al tratamiento inicial con MMC y se cambió a terapia a largo plazo con INF-alfa2b con un buen resultado. CONCLUSIONES: Cuando la MMC tópica administrada como tratamiento quimioterapéutico para la melanosis primaria adquirida con atipia o melanoma in situ no se tolera bien, el cambio a INF-alfa2b parece ser una buena opción. Este enfoque podría reemplazar el tratamiento quirúrgico de los tumores pigmentados, especialmente los más grandes, con beneficios potenciales que incluyen una menor dependencia de los márgenes quirúrgicos. Este caso sugiere la necesidad de estudios prospectivos diseñados para examinar el papel de INF-alfa2b como tratamiento primario para tumores conjuntivales densamente pigmentados que evitan la toxicidad de la superficie ocular causada por MMC

OBJECTIVE: To describe the clinical and histological resolution of a case of an inexcisable conjunctival melanoma using topical interferon alpha 2b (INFalfa2b) in a patient with mitomycin C (MMC) intolerance. CASE REPORT: Conjunctival melanoma is a rare, but potentially sight- and life-threatening, tumour. In cases of multiple lesions, or when surgical excision is not possible, topical combination chemotherapy with MMC and INFalfa2b has been described as first line therapy. The case is presented of a 77 year-old woman with a multifocal conjunctival in situ melanoma, who was intolerant to initial treatment with MMC and was switched to long-term INFalfa2b therapy, with a good outcome. CONCLUSIONS: When topical MMC is given as chemotherapy treatment for primary acquired melanosis with atypia or in situ melanoma is not well tolerated, switching to INFalfa2b seems to be a good option. This approach could replace surgical management of pigmented tumours, especially the larger ones, with potential benefits that include less dependence on surgical margins. This report prompts a need for prospective studies designed to examine the role of INFalfa2b as primary treatment for heavily pigmented conjunctival tumours avoiding the ocular surface toxicity caused by MMC

Resolution of conjunctival melanoma with topical interferon alpha 2b in a patient with mitomycin C intolerance. / Resolución de un melanoma conjuntival con interferón tópico alfa 2b en un paciente con intolerancia a la mitomicina C.

OBJECTIVE: To describe the clinical and histological resolution of a case of an inexcisable conjunctival melanoma using topical interferon alpha 2b (INFα2b) in a patient with mitomycin C (MMC) intolerance. CASE REPORT: Conjunctival melanoma is a rare, but potentially sight- and life-threatening, tumour. In cases of multiple lesions, or when surgical excision is not possible, topical combination chemotherapy with MMC and INFα2b has been described as first line therapy. The case is presented of a 77 year-old woman with a multifocal conjunctival in situ melanoma, who was intolerant to initial treatment with MMC and was switched to long-term INFα2b therapy, with a good outcome. CONCLUSIONS: When topical MMC is given as chemotherapy treatment for primary acquired melanosis with atypia or in situ melanoma is not well tolerated, switching to INFα2b seems to be a good option. This approach could replace surgical management of pigmented tumours, especially the larger ones, with potential benefits that include less dependence on surgical margins. This report prompts a need for prospective studies designed to examine the role of INFα2b as primary treatment for heavily pigmented conjunctival tumours avoiding the ocular surface toxicity caused by MMC.