Sara is a 3 year old girl brought in by Mum for a slowly enlarging brown spot on Conjunctiva of her left eye.
Differentials of a brown conjunctival spot
- Conjunctival Naevus
- Primary Acquired Melanosis
- Conjunctival Melanoma
- Ocular melanocytosis
- Racial Melanosis
Key features on examination of conjunctival melanoma (source)
- Elevated
- Well defined
- Age 50-60
Key features on examination of conjunctival naevus (source)
- Elevated
- Well defined
- Age 1-10
Key features on examination of primary acquired melanosis (source)
- Flat
- Poorly defined
- Age: Middle age
Differential diagnoses among conjunctival melanocytic lesions (source)
| TYPE OF LESION | LOCATION | AGE OF ONSET | MORPHOLOGY | PROGRESSION |
|---|---|---|---|---|
| Nevus | Epithelial conjunctiva, unilateral | First to second decade | Well-defined, elevated | 1% progression to conjunctival melanoma |
| Racial melanosis | Epithelial conjunctiva, bilateral | Congenital | Poorly defined, flat | Rare progression to conjunctival melanoma |
| PAM | Epithelial conjunctiva, unilateral | Middle age | Poorly defined, flat | If atypical, 50% progression to conjunctival melanoma |
| Ocular melanocytosis | Sclera, unilateral | Congenital | Poorly defined, flat | 1% progression to uveal melanoma |
| Melanoma | Stromal conjunctiva, unilateral | Sixth to seventh decade | Well-defined, elevated | Prognosis differs depending on extent |
More reading/ references
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3192085/
- https://www.aao.org/bcscsnippetdetail.aspx?id=2422bfaa-bf0b-451c-94de-c0608a0b05cf
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1. Shields CL, Shields JA. Tumors of the conjunctiva and cornea. Surv Ophthalmol. 2004;49(1):3–24.[PubMed]
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2. Shields CL, Fasiuddin AF, Mashayekhi A, Shields JA. Conjunctival nevi: clinical features and natural course in 410 consecutive patients. Arch Ophthalmol. 2004;122(2):167–75. Erratum in: Arch Ophthalmol2006;124(2):198. [PubMed]
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3. Gerner N, Nørregaard JC, Jensen OA, Prause JU. Conjunctival naevi in Denmark 1960–1980. A 21-year follow-up study. Acta Ophthalmol Scand. 1996;74(4):334–7. [PubMed]
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4. Kurli M, Finger PT. Melanocytic conjunctival tumors. Ophthalmol Clin North Am. 2005;18(1):15–24. vii. [PubMed]
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5. Folberg R, McLean IW, Zimmerman LE. Malignant melanoma of the conjunctiva. Hum Pathol. 1985;16(2):136–43. [PubMed]
