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      Case of a Giant Conjunctival Melanocytic Nevus

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          A 78-year-old female experienced extraocular extension of a giant conjunctival melanocytic mass. The clinical diagnosis was conjunctival malignant melanoma. We performed local excision and histopathological examination. The result of hematoxylin-eosin staining disclosed multiple intralesional mucosal cysts and nevus cell nests with abundant melanin. Immunohistochemical examination revealed expression of S-100, melan-A, and HMB-45 and no expression of Ki-67. Histopathological examination showed no evidence of malignancy. Giant conjunctival melanocytic nevi can be diagnostically confused with conjunctival malignant melanoma.

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          Most cited references 8

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          Clinical survey of 1643 melanocytic and nonmelanocytic conjunctival tumors.

          To report the spectrum and frequency of melanocytic and nonmelanocytic conjunctival tumors in an ocular oncology practice. Retrospective noninterventional case series. One thousand six hundred forty-three consecutive patients with a conjunctival mass evaluated at an ocular oncology department. A chart review was conducted to obtain the clinical features of the patient and tumor and to tabulate and categorize the diagnoses. Tumor diagnosis overall and relative to patient age, race, and gender and relative to tumor location and laterality. In 1643 consecutive patients, the tumor was classified as melanocytic in 872 cases (53%) and nonmelanocytic in 771 cases (47%). The nonmelanocytic categories included congenital choristomatous (n = 40 [2%]), epithelial (n = 219 [13%]), vascular (n = 63 [4%]), fibrous (n = 7 [ 60. Of the 219 patients with epithelial tumors, 80% occurred in males, whereas the incidence of melanocytic lesions was equal in males and females. African-American patients represented only 7% of epithelial tumors, <1% of melanomas, and 8% of lymphoid tumors. Conjunctival tumors were of melanocytic origin in 53% of cases and nonmelanocytic origin in 47%. Overall, melanocytic tumors, epithelial tumors, and lymphoid tumors accounted for 74% of all cases. These tumors were far more common in Caucasian patients, and epithelial tumors were found more frequently in men.
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            Conjunctival nevi: clinical features and natural course in 410 consecutive patients.

            To describe the clinical features of a conjunctival nevus and to evaluate the lesion for changes in color and size over time. Retrospective, observational, noncomparative case series. Four hundred ten consecutive patients with conjunctival nevi. The 2 main outcome measures were changes in tumor color and size. Of the 410 patients, 365 (about 89%) were white, 23 (about 6%) were African American, 8 (2%) were Asian, 8 (2%) were Indian, and 6 (1%) were Hispanic. The iris color was brown in 55% (229/418), blue in 20% (85/418), green in 20% (83/418), and not indicated in 5% (21/418). The nevus was brown in 65%, tan in 19%, and completely nonpigmented in 16%. The anatomical location of the nevus was the bulbar conjunctiva (302 eyes, 72%), caruncle (61 eyes, 15%), plica semilunaris (44 eyes, 11%), fornix (6 eyes, 1%), tarsus (3 eyes, 1%), and cornea (2 eyes, <1%). The bulbar conjunctival lesions most commonly abutted the corneoscleral limbus. The nevus quadrant was temporal (190 eyes, 46%), nasal (184 eyes, 44%), superior (23 eyes, 6%), and inferior (21 eyes, 5%). Additional features included intralesional cysts (65%), feeder vessels (33%), and visible intrinsic vessels (38%). Cysts were clinically detected in 70% of histopathologically confirmed compound nevi, 58% of the subepithelial nevi, 40% of the junctional nevi, and 0% of the blue nevi. Of the 149 patients who returned for periodic observation for a mean of 11 years, the lesion color gradually became darker in 5% (7 patients), lighter in 8% (12 patients), and was stable in 87% (130 patients). The lesion size was larger in 7% (10 patients), appeared smaller in 1% (1 patient), and was stable in 92% (137 patients). There were 3 patients who developed malignant melanoma from a preexisting compound nevus (2 cases) or blue nevus (1 case) over a mean interval of 7 years. Conjunctival nevus is a benign tumor most often located at the nasal or temporal limbus and rarely in the fornix, tarsus, or cornea. Over time, a change in tumor color was detected in 13% (20/149) and a change in tumor size was detected in 8% (12/149).
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              Conjunctival naevi in Denmark 1960-1980. A 21-year follow-up study.

              The clinicopathological characteristics of 343 naevi of the conjunctiva were studied. A significant increase in the number of naevi excised per annum was observed. This may have been caused by an increased exposure to actinic rays. Approximately even distribution in the three main locations: caruncle, limbal area and eyeball, was found. Intrastromal naevi were excised at a higher median age than compound naevi, and the lowest observed median age at excision was for junction naevi, which is in accordance with the known histopathological nature of naevi. Recurrence occurred in nine patients (2.7%), and one transformed to a malignant melanoma. Eight of the recurring naevi were located in the limbal area. Eight of the nine patients were women, suggesting hormonal factors as a possible cause. Recommendations for the handling of conjunctival naevi are given, based on the present findings and on previous reports.

                Author and article information

                Ocular Oncology and Pathology
                S. Karger AG
                March 2021
                18 December 2020
                : 7
                : 2
                : 97-102
                Department of Ophthalmology, Kansai Medical University, Osaka, Japan
                Author notes
                *Hidetsugu Mori, Kansai Medical University, Department of Ophthalmology, 2-5-1 Shinmachi, Hirakata, Osaka 573-1191 (Japan), morih@hirakata.kmu.ac.jp
                508891 Ocul Oncol Pathol 2021;7:97–102
                © 2020 S. Karger AG, Basel

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                Figures: 5, Pages: 6
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