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Conjunctival Melanoma: Current Treatments and Future Options

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Abstract

Conjunctival melanoma is a rare tumor of the conjunctival epithelium with a heterogenous clinical presentation and a propensity for regional and distant metastatic spread. Guidelines for the treatment of local conjunctival melanoma are well-established, but there are no standard efficacious therapies for metastatic disease. Given that conjunctival melanoma is genetically similar to cutaneous melanoma and mucosal melanomas, targeted therapies effective in the treatment of these diseases, such as BRAF inhibitors and KIT inhibitors, may be effective in the treatment of patients with metastatic conjunctival melanoma. Other targeted small-molecule drugs in the drug development pipeline for the treatment of more prevalent melanomas could also be applicable to conjunctival melanoma. Furthermore, systemic immunotherapy treatments that are now a mainstay in the treatment of cutaneous melanoma, such as programmed cell death-1 and cytotoxic T lymphocyte-associated antigen-4 inhibitors, could also stand to benefit patients with metastatic conjunctival melanoma. Limited case reports provide clues about the effectiveness of both targeted small-molecule inhibitors and immunotherapy in patients with advanced local and metastatic conjunctival melanoma and give credence to the argument that conjunctival melanoma patients should be included in major trials studying new therapies in both cutaneous and mucosal melanomas where applicable.

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Fig. 1

Photo from the practice of Brian Marr, M.D.

Fig. 2

Photo from the practice of Brian Marr, M.D.

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Authors and Affiliations

  1. Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Joseph M. Grimes & Nirav V. Shah

  2. Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA

    Faramarz H. Samie

  3. Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA

    Richard D. Carvajal

  4. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA

    Brian P. Marr

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  1. Joseph M. Grimes
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Correspondence to Brian P. Marr.

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No external funding was used in the preparation of this manuscript.

Conflict of interest

Joseph M. Grimes, Nirav V. Shah, and Faramarz H. Samie, M.D. declare that they have no conflicts of interests that might be relevant to the contents of this review. Brian P. Marr, M.D. provides consulting services for Aura Biosciences, Castle Biosciences, and Immunocore. Richard D. Carvajal, M.D. provides consulting services for Array, BMS, Castle Biosciences, Compugen, I-Mab, InxMed, Merck, Pierre Fabre, PureTech Health, Sanofi Genzyme, and Sorrento Therapeutics; is on scientific advisory boards for Aura Biosciences, Chimeron, and Rgenix; and receives research funding to Columbia University from Amgen, Array, Astellas, AztraZeneca, Bayer, Bellicum, BMS, Corvus, Eli Lilly, Ideaya, Immunocore, Incyte, Macrogenics, Merck, Mirati, Novartis, Pfizer, Plexxikon, and Roche/Genentech.

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Grimes, J.M., Shah, N.V., Samie, F.H. et al. Conjunctival Melanoma: Current Treatments and Future Options. Am J Clin Dermatol 21, 371–381 (2020). https://doi.org/10.1007/s40257-019-00500-3

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