Cryotherapy for conjunctival primary acquired @entity1709 and XXXX . Experience with 62 cases.

@entity1 @entity910 @entity1709 @entity3 @entity320
Sixty-two @entity1 were treated by some combination of cryotherapy and surgery with an average follow-up of 3.3 years for one of the following diseases: focal or diffuse flat conjunctival primary acquired @entity1709 (PAM) with atypia but without a nodule of @entity320 (10 cases); unifocal @entity320 with or without focal or diffuse PAM (30 cases); and multinodular/multicentric @entity320 with and without PAM (22 cases). Of the ten @entity1 who had PAM with atypia, invasive nodules of @entity320 did not develop. A second treatment was required to control the disease in four of the ten @entity1 with extensive or diffuse lesions, and one has mild persistent disease. Of the 30 @entity1 with unifocal nodules of @entity320 , 27 remained free of recurrence after one treatment, and 2 are asymptomatic after two treatments. One @entity1 with a thick nodule at presentation required a parotidectomy and radical neck dissection for cervical @entity3 after recurrence in the conjunctival sac. In the group of 22 @entity1 with multinodular @entity320 , only two did not have recurrent disease after one treatment. Of those who received multiple therapies, seven remained free of recurrence for at least 2 years after the last treatment; regional or distant @entity3 developed in nine; four required exenteration; and eight died. Conjunctival adjunctive cryotherapy avoids exenteration in extensive lesions of pure PAM and in unifocal @entity320 , but even after multiple therapies, multinodular @entity320 had a 45% rate of @entity3 . @entity3 was related to the presence of PAM sine pigmento in four @entity1 (microscopically but not clinically detectable PAM); to the location of the nodules (9 of 10 @entity1 who experienced @entity3 had forniceal, @entity910 ); to the thickness or depth of invasion of the nodules (greater than 2 mm); and to the development of intralymphatic spread ("in-transit" local @entity3 ) within the conjunctival sac in six @entity1 . No @entity3 were encountered among @entity1 with strictly limbal nodules and among five @entity1 with invasive nodules composed of spindle cells in part or in toto. Therapeutic success in this spectrum of melanocytic proliferations is closely correlated with the clinical extent of the disease when initiating definitive therapy.
