Conjunctival tumor

What is a conjunctival tumor?

Tumors can develop on the conjunctiva as well as on all other tissues in the body. These conjunctival tumors can be benign and malignant. The benign conjunctival tumors are far more common. They include the so-called Limbal dermoid and Conjunctival papillomas. A tumor does not necessarily have to mean cancer. In principle, a tumor is just excessive new tissue formation that can be traced back to mutations in the genetic material. In the case of a benign tumor such as the limbal dermoid, however, the additional tissue does not cause any damage, since there is no risk of malignant degeneration. A benign conjunctival tumor is limited to the conjunctiva and does not grow into the adjacent tissue. However, since they are aesthetically striking and do not correspond to the general ideal of beauty, the benign conjunctival tumors are also often removed.

What tumors are there?

Conjunctival melanoma

Similar to the rest of the skin, black skin cancer can also develop on the conjunctiva. On the conjunctiva this is called conjunctival melanoma. A conjunctival melanoma is a malignant, i.e. malignant, conjunctival tumor. This develops over time from an initially benign melanosis, i.e. an excessive increase in pigment cells in the conjunctiva. Due to the large number of pigment cells, the conjunctival melanoma also appears dark brown to black. Due to the dark color, the conjunctival melanoma can be recognized very well on the otherwise white conjunctiva as a delimited, black and mostly roundish spot that often grows a little protruding. Since conjunctival melanoma is a malignant conjunctival tumor, early removal is advisable and regular follow-up examinations at the ophthalmologist should be carried out. If a conjunctival melanoma is not removed, there is a risk that it can grow into deeper layers of the eye and metastasize.Preferred metastatic routes for conjunctival melanoma are the adjacent lymph nodes in the head and neck area. At this point, conjunctival melanoma is very difficult to treat and the complication rate is high.

You might also be interested in: What is melanoma

Conjunctival lymphoma

The conjunctival lymphoma is also a malignant, i.e. malignant, conjunctival tumor. It usually grows as a salmon-colored, rosy protrusion in the lower fold of the lower eyelid, on the side facing the eye. Since it looks outwardly similar to the harmless conjunctivitis, i.e. conjunctivitis, it can sometimes lead to hasty misdiagnoses.

The conjunctival lymphoma should be surgically removed due to its malignant growth. It is not uncommon for conjunctival lymphoma to occur as part of a systemic disease that affects the entire body. Therefore, when diagnosing conjunctival lymphoma, further malignant processes should always be looked for in the patient. However, if the conjunctival lymphoma is removed in good time and there are no further organ involvement, it has a good prognosis.

In childhood, conjunctival lymphomas occur more frequently as part of generalized non-Hodgkin lymphoma. This is a specific type of lymphoma that originates from special cells in the blood, and is therefore colloquially referred to as "blood cancer". The disease can be malignant in different ways. In children from Africa, there is an increased incidence of conjunctival lymphomas based on a Burkitt tumor (which is endemic in Africa).

Also read: What is lymphoma

Detecting a conjunctival tumor

What are the symptoms of a conjunctival tumor?

A conjunctival tumor usually causes comparatively few symptoms in the patient. These depend primarily on the location, size and type of the conjunctival tumor. Over time, patients often notice a small, darker discoloration of the otherwise white conjunctiva, which does not disappear over time, but rather increases in size and intensity. Sometimes the discoloration is also slightly raised, so it appears as a kind of small nodule on the otherwise smooth conjunctiva.

Vision itself remains completely unaffected by a conjunctival tumor. Some patients describe a foreign body sensation in the eye or a slight swelling, especially as the conjunctival tumor increases in size. The feeling of foreign bodies or the nodular elevation of the tumor can lead to irritation and redness of the conjunctiva, dry eyes and additional conjunctivitis. Regardless of the discoloration caused by the conjunctival tumor, the eye will then appear red and tearing may increase. However, the conjunctival tumor itself does not cause any pain. The vision can only be limited somewhat in later stages, when the tumor has already increased so much in size that the eye can no longer be completely closed or the visual axis is no longer aligned. However, these are extreme cases that are no longer to be found in our medically highly developed countries.

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• Conjunctivitis
• Blindness

How is a conjunctival tumor diagnosed?

Since conjunctival tumors are tumors on the outer segment of the eye, i.e. the front area that is visible from the outside, they are usually easy to see with the naked eye. Nevertheless, it is essential to see a knowledgeable ophthalmologist so that he can take a closer look at and assess the changes in the conjunctiva using various instruments. The standard is the examination with the slit lamp, which allows a good view of the conjunctiva and the rest of the anterior segment of the eye.

In addition, the ophthalmologist can artificially expand the pupil with eye drops and thus gain a rough overview of what is happening inside the eye and the back of the eye, such as the retina. This is important in order to be able to assess the extent and growth of the tumor.

The ophthalmologist will also want to use imaging techniques to document the findings photographically (which is important to assess the rapidity of growth) and to use cross-sectional imaging techniques to examine whether the conjunctival tumor has already spread to the deeper layers Has.

Finally, and ultimately decisive for a final diagnosis, a sample is taken. This can then be sent to the pathology department, where it is examined in detail and, using genetic diagnostic methods, enables precise differentiation between the individual types of conjunctival tumors. If necessary, when the sample is taken, an attempt is made to remove the entire conjunctival tumor and send it to the pathology department.

Treating a conjunctival tumor

How do you remove a conjunctival tumor?

Since a conjunctival tumor is a pathological increase in tissue on the conjunctiva, surgical removal is ultimately the only way to remove this tissue growth. But surgery is not required in every case of conjunctival tumors.

Benign conjunctival tumors, such as the conjunctival papilloma or the limbal dermoid, are usually not removed. They are not at risk of malignant degeneration and their growth is so slow that they do not need to be removed. However, since they represent a cosmetic problem for some patients and cannot be reconciled with their personal sense of aesthetics, they are often removed. Depending on the condition of the conjunctival tumor and the patient, the procedure is performed under local or short-term anesthesia. The conjunctival tumor is then cut out with a fine scalpel and the conjunctiva is glued or sutured if necessary.

It is different with malignant conjunctival tumors, such as conjunctival melanoma or conjunctival lymphoma. They are degenerate cancer cells that can potentially grow into the surrounding tissue layers and, in the worst case, can spread throughout the body. Therefore, an operation must be performed here in any case. Depending on the type of tumor, chemotherapy or cryotherapy (the freezing of a certain area) can be considered as an alternative or in addition, but this must be decided by the ophthalmologist in consultation with the histopathologist. The procedure is analogous to the removal of benign tumors, except that a larger area may be removed in order to also remove “invisible” tumor cells.

Whether benign or malignant, in both cases the removed tissue is then examined again by a pathologist and evaluated to determine whether any remaining cells in the eye need to be removed or whether the tumor has been completely cut out.

For more information, see: Eye surgery

Prevention of a conjunctival tumor

What are the causes of a conjunctival tumor?

The causes of conjunctival tumors are just as diverse as their manifestations and degrees of severity. Like most tumor diseases, a mutation in the genetic material, i.e. in the genes, is responsible for the pathological growth of the tissue in conjunctival tumors. These mutations can now come about purely by chance, due to small errors that occur in our cells during the permanent regeneration and duplication processes. Or caused by external influences. Mutagenic materials and substances primarily include many types of radiation. But not only radioactive radiation, such as occurs in nuclear power plants, is harmful to our genetic make-up. Everyday radiation in the sun's rays, so-called UV A and UV B radiation, can penetrate through our skin into the genes and start mutation processes there. As a result, it can happen that individual pathological cells degenerate and grow and multiply unchecked. These cells then form the initial tumor cells.

For benign tumors such as the Limbal dermoid or that Conjunctival papilloma, the tumor cells continue to grow unchecked and displace the healthy surrounding tissue, but do not penetrate into it and also do not impair its structure and function.

This is not the case with the malignant tumor cells, which both increase in number and size and continue to expand and grow into other cells and destroy them. This is the case with the Conjunctival lymphoma. Malignant tumors should be treated as soon as possible. Depending on the type and severity of the conjunctival tumor, treatment consists of surgical removal of the tumor and, if necessary, chemotherapeutic follow-up treatment. In the case of benign tumors, it is often sufficient to regularly check their growth and only initiate appropriate treatment when the tumor growth has progressed rapidly.

You can also find important information at:

• Therapy of lymphoma
• Conducting chemotherapy

Course of a conjunctival tumor

What is the prognosis for a conjunctival tumor?

The prognosis of a conjunctival tumor depends on the type of tumor. The time of diagnosis is also important, as growth may have progressed further, depending on the situation. Benign conjunctival tumors are harmless and only represent a cosmetic impairment of the eye. In principle, they do not have to be removed and could remain in the eye until the end of their life if it does not bother the patient.

Malignant conjunctival tumors, on the other hand, especially conjunctival melanoma (black skin cancer of the conjunctiva), must be removed as early as possible and, if necessary, additionally irradiated or treated with chemotherapy. Conjunctival melanoma, in particular, tends to grow and metastasize quickly. Once this stage is reached, treatment is difficult and a complete cure is unfortunately unlikely. In general, a close follow-up check by the attending ophthalmologist is of great importance in order to be able to recognize and treat a possible progression of tumor growth or, after the operation, a recurrence of tumor cells in good time. Unfortunately, conjunctival tumors are very prone to recurrence. This means that the likelihood of developing a conjunctival tumor again after surgical removal is relatively high. It is all the more important to be in contact with the ophthalmologist, to examine yourself regularly and to be attentive.