結膜および眼瞼悪性黒色腫に対し，炭酸ガスレーザーと局所化学療法を行った1例

A case of malignant melanoma in the conjunctiva and eyelid treated by carbon dioxide laser and local chemotherapy

要約　目的：炭酸ガスレーザーと化学療法で治療した結膜と眼瞼の悪性黒色腫の症例報告。症例：77歳女性の左眼球結膜上方に黒褐色腫瘤が3年前に生じた。下方球結膜と下眼瞼にも同様な腫瘤が出現し，次第に拡大して受診した。小児期より左眼下眼瞼に母斑様の黒色腫瘤があった。所見と経過：左眼の下眼瞼縁に黒褐色腫瘤，球結膜上方の輪部に沿う扁平な黒色斑，下円蓋に隆起性の黒褐色腫瘤，上下の瞼結膜に黒色の色素斑の散在があった。球結膜と眼瞼縁腫瘤を切除し，悪性黒色腫と組織診断した。球結膜と瞼結膜の色素斑に炭酸ガスレーザーを照射した。マイトマイシンCの点眼，抗癌薬の全身投与，インターフェロン-βの結膜下注入を行った。下眼瞼縁の再発に対して再切除と，瞼球癒着などに対して形成手術を行った。初回治療から1年間，これ以外の再発はない。結論：球結膜の悪性黒色腫に，炭酸ガスレーザー照射と局所化学療法が奏効した。

Abstract.　Purpose：To report a case of malignant melanoma in the conjunctiva and eyelid. Case：A 77-year-old woman noted a pigmented tumor in the upper conjunctiva in her left eye 3 years before. Another tumor appeared and enlarged in the lower conjunctiva and eyelid. She had had a pigmented tumor in her left lower eyelid since childhood. Findings and Clinical Course：Her left eye showed a pigmented tumor in the lower eyelid. A pigmented lesion was present along the upper limbus. An elevated pigmented tumor was present in the lower fornix. Pigmented patches were present in the upper and lower palpebral conjunctiva.We resected the tumors in the bulbar conjunctiva and the eyelid,leading to the histopathological diagnosis of malignant melanoma. Carbon dioxide laser was applied to pigmented patches in the bulbar and palpebral conjunctiva.In addition to systemic chemotherapy,the left eye received mitomycin C instillation and subconjunctival interferon-β. Recurrence in the eyelid was treated by resection. Otherwise,there has been no recurrence during one year of follow up. Conclusion：Resection followed by carbon dioxide laser irradiation and local chemotherapy was effective for malignant melanoma in the conjunctiva and eyelid.