Simultaneous conjunctival melanomas in one eye treated with both adjuvant brachytherapy and proton beam radiotherapy.

Purpose: We describe a rare case of two simultaneous primary conjunctival melanomas in the same eye that were treated sequentially with both plaque brachytherapy and proton beam radiotherapy following wide surgical excision. Observations: A 66-year-old male presented with two pigmented lesions that were concerning for conjunctival melanoma. One of the lesions was on the bulbar conjunctiva near the corneal limbus, and the other in the lower fornix. The lesions were surgically removed using the "no touch" technique, and pathology confirmed invasive melanoma in two separate locations on the same eye. The two lesions were then treated separately with two different forms of adjuvant radiation therapy. The forniceal tumor was treated with proton beam radiotherapy and the limbal lesion was treated with plaque brachytherapy. 30 months after radiation therapy was completed, there were no signs of local recurrence. Conclusions and importance: The appropriate treatment for two primary malignancies in the same eye can be determined independently and, in some cases, can involve two different forms of radiation therapy.