Ultra-high-frequency ultrasound in the detection of recurrent conjunctival melanoma: A case report

Abstract

BACKGROUND

Conjunctival melanoma is rare and prone to local recurrence, and optimal surveillance imaging of the ocular surface and periocular skin is not standardized. We report the use of ultra-high-frequency ultrasound (UHFUS) to map multiple clinically subtle recurrent nodules in a previously treated conjunctival melanoma (Co-M) patient undergoing immunotherapy. This case supports incorporating UHFUS into multidisciplinary follow-up, showing how it can non-invasively detect occult recurrence and guide staging and treatment planning.

CASE SUMMARY

A middle-aged patient with a history of conservatively treated left Co-M was referred for suspected local recurrence, reporting a new palpable subcutaneous lump near the lateral orbital rim and a pigmented lesion at the medial canthus of the same eye. Clinical examination confirmed a periocular nodule suggestive of relapse. Cervical lymph node ultrasound showed no suspicious lymphadenopathy. UHFUS (48 MHz) with Doppler of the periocular region revealed epidermal thickening at the medial canthus and three subepidermal nodules in the lower eyelid and lateral canthus, with irregular morphology and increased vascularity, highly suggestive of recurrent melanoma and satellite lesions. The patient was already receiving first-line anti-programmed cell death 1 immunotherapy; high-frequency ultrasound findings refined local staging, confirmed absence of nodal involvement, and supported multidisciplinary planning and imaging-based follow-up.

CONCLUSION

UHFUS can non-invasively detect and map recurrent Co-M, improving local staging and guiding multidisciplinary follow-up.

Keywords: High-frequency-ultrasound; High-resolution imaging; Melanoma; Ultra-high-frequency ultrasound; Conjunctival melanoma; Case report

Core Tip: This case report describes recurrent conjunctival melanoma in a previously treated eye, evaluated with ultra-high-frequency ultrasound (UHFUS) (48 MHz). UHFUS accurately depicted subtle periocular epidermal thickening and multiple subepidermal nodules not fully appreciated on clinical examination, while confirming the absence of suspicious cervical lymph nodes. Integrating UHFUS into multidisciplinary follow-up refined local staging in a patient on anti-programmed cell death 1 therapy and supported an imaging-based, organ-preserving management strategy.