Vol. 7, Issue 2, Part D (2025)

Conjunctival malignant melanoma is an uncommon but aggressive ocular surface cancer with a significant risk of recurrence and metastasis. Standard treatment comprises wide local excision with cryotherapy; nevertheless, incomplete excision frequently occurs, necessitating adjuvant therapy. Topical Mitomycin C has emerged as a useful adjuvant for killing residual tumor cells while protecting ocular tissues. We present the case of a 74-year-old male with a rapidly growing pigmented conjunctival lesion of the right eye, coupled with tears and mucous discharge. Ocular examination revealed a nodular, pigmented conjunctival mass (10 × 4 mm) with feeder vessels, stretching from 6 to 10 o’clock on the bulbar conjunctiva. Visual acuity was 3/60 in the right eye. The patient had broad local excision with cryotherapy and amniotic membrane transplantation. Histopathology confirmed conjunctival malignant melanoma with tumor cells at numerous margins, indicating incomplete excision. Adjuvant topical Mitomycin C 0.04% given 2.5 months after excision and provided in four cycles (four consecutive days per cycle, four times daily, with one-week intervals). The patient tolerated the regimen with just minor conjunctival hyperemia. At 6-month follow-up, the ocular surface was stable, visual acuity improved to 20/63 in the right eye, and neither local recurrence or systemic metastasis was observed. This case illustrates the importance of adjuvant topical Mitomycin C as an effective and well tolerated therapy for conjunctival malignant melanoma with positive surgical margins. In older patients with systemic comorbidities, Mitomycin C is a practical organ-preserving approach for local tumor treatment. Long term surveillance remains crucial to detect late recurrence or metastasis.