Conjunctival melanoma with metastasis to the parotid gland in a 10 year-old boy: A case report and literature review

Abstract Conjunctival melanoma is a rare invasive neoplasm, usually seen in middle-aged and elderly persons. Its incidence in the adult population seems to be on the rise but it remains extremely rare in children with only few reported cases. Conjunctival melanoma metastasizing to the parotid has been reported in few cases in adults; whereas in the pediatric population only two cases of conjunctival melanoma metastasis have been reported from which only one is to the parotid gland. Methods : A case report of conjunctival melanoma and secondary metastasis to the ipsilateral parotid gland in 10 year-old boy and literature review. Case report : A 10 year-old boy, previously healthy, presented to the ophthalmology service for left conjunctival nevus that was surgically excised after a rapid increase in size. The histopathologic diagnosis came out as melanoma. He presented 1month after excision with left preauricular node. MRI study showed a parotid lymph node with a necrotic center that was also positive on PET scan. Fine needle aspiration cytology revealed metastatic melanoma. Following a complete negative workup for other metastatic disease, the patient underwent left total parotidectomy with facial nerve preservation and ipsilateral neck dissection. Plaque brachytherapy was given for local control of the conjunctival lesion. Post operatively he received systemic chemotherapy with interferon-α2b and left neck radiotherapy with no evidence of recurrence or metastasis after almost 1 year post-diagnosis. Conclusion : Malignant melanomas of the conjunctiva are extremely rare in children and even more rare to present with metastasis. We hereby present the second case of conjunctival melanoma metastatic to the parotid in a pediatric patient.