Topical chemotherapy for the treatment of melanocytic conjunctival tumors: An updated review

Abstract

Melanocytic conjunctival tumors including conjunctival melanoma and primary acquired melanosis with atypia, are rare but aggressive, capable of local invasion, systemic spread, and recurrence despite treatment. While surgery remains the standard approach, topical chemotherapy using mitomycin C and interferon alpha-2b has emerged as an alternative. This systematic review, analyzed 22 studies encompassing 116 cases. Among these, 28 cases were treated with mitomycin C as a primary therapy achieving a 60.7% remission rate, and 48 were treated with mitomycin C as adjuvant therapy yielding a 68.8% remission rate. Interferon alpha-2b achieved 87.5% remission across primary and adjuvant applications. Overall, remission was achieved in 74.1% of cases (86 patients). Topical chemotherapy provides a non-surgical approach that treats the entire conjunctival surface eliminating reliance on precise tumor margin identification. Primary mitomycin C demonstrated efficacy in managing diffuse, superficial, and intraepithelial disease whereas adjuvant was more effective for nodular and invasive lesions. Interferon alpha-2b, associated with fewer adverse effects, is a valuable alternative, particularly in cases intolerant to mitomycin C. These findings underscore the potential of topical chemotherapy as both a primary and adjuvant option, highlighting the need for further studies to refine treatment protocols and assess long-term outcomes.