Conjunctival melanoma is an extremely rare form of eye melanoma that develops in the conjunctiva, the clear tissue that covers the white part of the eye (sclera) and the inside of the eyelids. It often appears as a raised or pigmented lesion (though sometimes amelanotic, or non-pigmented) and most commonly occurs on the bulbar conjunctiva, the membrane that covers the outer surface of the eyeball. 

Conjunctival melanoma represents about 2% of all eye tumors and 0.25% of all melanomas. Registry data from multiple countries suggest an incidence between 0.24–0.8 cases per million people each year. While still rare, rates appear to be slowly increasing, similar to cutaneous melanoma suggesting a possible association with ultraviolet (UV) exposure. Unlike uveal melanoma, which tends to spread to the liver, conjunctival melanoma is more likely to metastasize to regional lymph nodes or the lungs.

Diagnosis usually begins with a comprehensive eye exam by an ophthalmologist or ocular oncologist. The doctor examines all conjunctival surfaces, including the inside of the eyelids, and photographs are often taken prior to biopsy to document the extent of disease. 

A biopsy confirms the diagnosis through microscopic examination of the tissue. Once conjunctival melanoma is diagnosed, patients should discuss staging and treatment options with a specialized ocular oncology team. Because conjunctival melanoma spreads more like cutaneous melanoma, staging and prognosis often incorporate lymph node assessment, including sentinel lymph node biopsy (SLNB) in selected cases.

The standard treatment for conjunctival melanoma is surgical excision with wide local margins. Enucleation (eye removal) is rarely performed and does not appear to improve overall survival unless disease is extensive. 

To reduce the risk of local recurrence, surgery is often followed by adjuvant therapy, which may include: 

Patients should undergo long-term follow-up with an ocular oncologist to monitor for local recurrence or metastasis.

Conjunctival, uveal, and cutaneous melanomas are distinct biologic diseases that require different treatment strategies. However, when conjunctival melanoma spreads, it behaves more like cutaneous melanoma, typically spreading first to lymph nodes and then potentially to the lungs, liver, soft tissue, bone, or brain. 

Risk factors for metastasis include: 

These factors overlap with known prognostic indicators in cutaneous melanoma and are used in staging and risk assessment.

There are no FDA-approved systemic therapies specifically for conjunctival melanoma. However, many oncologists use cutaneous melanoma treatments when appropriate, including: 

Clinical Trials: Clinical trials should be explored as a treatment option for anyone diagnosed with conjunctival melanoma. Learn more about trials here!