Recurrent Conjunctival Melanoma Managed with Long-Term Eye-Preserving Treatment Followed by Delayed Eyelid Metastasis: A Case Report

Background: Conjunctival melanoma is a rare but potentially aggressive ocular surface malignancy characterized by frequent local recurrence and risk of metastatic spread. In carefully selected cases, depending on tumor extent, clinical course, and patient condition, management may require balancing oncologic control with preservation of the globe, visual function, and quality of life. Case Presentation: We report the case of a 78-year-old woman with amelanotic conjunctival melanoma of the left eye. Initial treatment consisted of wide local excision using a no-touch technique, conjunctival autograft reconstruction, and adjuvant topical Mitomycin C (MMC). During a 10-year follow-up period, the patient developed multiple local recurrences requiring repeated surgical excisions and additional MMC therapy. Despite the chronic relapsing course, useful visual function and globe preservation were maintained. In December 2024, a subcutaneous lesion of the upper eyelid was detected and histopathologically confirmed as locoregional metastasis from the primary conjunctival melanoma. Given the patient’s advanced age, preserved visual function, absence of documented distant metastatic disease, and overall clinical context, management continued with a conservative, eye-preserving approach. Conclusions: This case illustrates that prolonged eye preservation may be achievable in carefully selected patients with recurrent conjunctival melanoma through repeated conservative management. However, this strategy does not eliminate the risk of delayed progression and requires individualized decision-making together with long-term surveillance.