Benign melanocytic naevi in various sites may show unusual histopathological features that may mimic melanoma. It resembles linear psoriasis both clinically and histologically. It is not clear if patients with dysplastic nevus syndrome have higher incidence of conjunctival nevi. Cellular blue nevus of the conjunctiva can simulate primary acquired melanosis and can give rise to. The lesion presents as persistent linear, pruritic eruptions. Overview nonneoplastic diseases of the eyelid skin nonneoplastic diseases. Among conjunctival tumors, melanocytic lesions represent 53% of all excised conjunctival lesions. Grossly, the lesion is located in the bulbar conjunctiva and has various pigmentation and shapes, including melanotic or. There is a recently recognized and relatively common group of melanocytic naevi that share histopathologic features in common with dysplastic naevi and malignant melanoma. A 64yearold white female was evaluated for a darkening pigmented lesion of the left lower palpebral conjunctiva. The histopathological diagnosis suggested a conjunctival nevus.
Management of primary acquired melanosis, nevus, and conjunctival melanoma andrew kao, md, armin afshar, md, michele bloomer, md, and bertil damato, md, phd photo courtesy of lynn e. In 1895, jadassohn first described nevus sebaceous see the image below, a circumscribed hamartomatous lesion predominantly composed of sebaceous glands. Melanocytic lesions of the conjunctiva archives of. Naevi from the auricular region, breast, conjunctiva and ankle sometimes have a rather atypical proliferation of melanocytes in the epidermis, often with pagetosis and cytological atypia.
Nevus or nevi if multiple is a nonspecific medical term for a visible, circumscribed, chronic lesion of the skin or mucosa. Multifocal blue nevus of the conjunctiva request pdf. A complexion melanosis appearing as diffuse conjunctival pigmentation in a pigmented individual. Melanocytic nevi are the most common tumors of the conjunctiva, accounting for 28% of all neoplastic lesions.
However, a number of other lesions have a similar appearance but a different source, such as pigment deposits from silver and iron. It can be clinically confused with more common conditions, such as conjunctival nevus or primary acquired melanosis. Melanocytic naevi of special sites diagnostic histopathology. Virtual slides the virtual slides for this article can be found here. Inflamed conjunctival nevi icn may suggest malignancy because of their rapid growth and atypical histology. Summary conjunctival nevus is the most common conjunctival tumor in children and fewer than 1% evolve into melanoma over time.
Tm these tumors are primarily related to ultraviolet uv exposure. Melanocytic lesions of the conjunctiva have a similar morphologic appearance to those of the skin. Conjunctival nevus is a benign, noncancerous growth and is the most common lesion that occurs on the surface of the eye. Pathology of conjunctiva tatyana milman the conjunctiva is a mucous membrane that plays a critical role in maintaining ocular health by forming a smooth, flexible, and protective sac covering the pericorneal surface of the eye. Results of 618 patients with conjunctival nevus, 32 5% were classified as having giant conjunctival nevus.
B histopathology of a blue nevus characterized by pigmented slender fusiform and dendritic melanocytes in the subepithelial stroma 310, hematoxylin and eosin. These naevi have been termed naevi of special sites or naevi with siterelated atypia as distinctive features have been correlated with specific anatomic sites. Special consideration is given to the management of conjunctival nevus and pam. Finger says, think of sunglasses as sun block for your eyes. Of those with giant conjunctival nevus, a history of an increase in nevus base or thickness was noted in 15 cases 47% and an increase in color intensity in 2 cases 6%. Conjunctival nevus, also nevus of the conjunctiva, is a benign melanocytic lesion. Several types of naevi can be identified in the conjunctiva, with some sitespecific peculiarities, familiarisation with which. Pdf a juvenile case of conjunctival atypical nevus researchgate. Four melanocytic nevi and eight melanomas of the conjunctiva were analyzed. Conjunctival melanoma and melanocytic intraepithelial.
It is usually a discrete lesion on the conjunctiva the clear film over the eye and can range from dark brown to yellow color, and many times will contain clear cystic components. Pigmented lesions that arise from the conjunctiva include nevus, complexionassociated melanosis cam, primary acquired melanosis pam, and malignant melanoma. Change in nevus color over time has been noted in 5% of cases and change in nevus size has been documented in 7%. Conjunctival melanocytic nevi may be confined to the conjunctival mucosa junctional nevus, involve both the mucosa and submucosa compound nevus, or are located only in the stroma subepithelial nevus. Pdf a total of 2455 conjunctival lesions in adults over 15 years old obtained. Nevi and pam without atypia have a benign clinical course and are similar to nevi and lentigos in the skin. For most children with conjunctival nevus, observation is provided and the tumor is. Pathology of epidermal nevus and inflammatory linear. Several types of naevi can be identified in the conjunctiva, with some sitespecific peculiarities. Among the benign intraepithelial melanocytic proliferations, conjunctival nevi cn are the most common conjunctival neoplasm. The management of conjunctival melanoma is difficult because of the rarity of the disease. The most important predisposing factor for conjunctival melanoma is the presence of longstanding conjunctival nevus or pam. C nevus shown as a slightly elevated pigmented lesion with intraepithelial cysts.
Conjunctival tissue tumors have a varied presentation, and few series studies on pediatric patients have been published. After puberty, histologic features characteristically include papillomatous hyperplasia of the epidermis, a large number of mature or nearly mature sebaceous glands, and a lack of terminally differentiated hair follicles. Pathology of the eyelids, conjunctiva and orbit philippe labelle, dvm, dacvp antech diagnostics. Of 85 histopathologic specimens, compound nevus was the most common histologic diagnosis and accounted for 67.
Sebaceous nevi and verrucous epidermal nevi are closely related, and many authors regard them as variants. Histologic features of conjunctival melanoma predictive of. Similarly to when they occur in the skin, nevi can be congenital, if they appear at birth or. The objective of this paper is to report the histopathologic diagnoses spanning over 198820 of conjunctival tumors in children younger than 14 years. The histopathologic diagnoses in the 148 excised lesions are listedin. B primary acquired melanosis manifesting as a discrete patch of conjunctival pigment. One 22year old patient had bilateral compound conjunctival nevi. Nevi are the most common, found in 52% of the cases, followed by melanoma in 25%, primary acquired melanosis pam in 21%, and racial melanosis in 3%. Objectivesto describe the clinical features of a conjunctival nevus and. The caruncle is a modified cutaneous tissue located at the inner canthus that contains hair follicles, accessory lacrimal glands, sweat glands and sebaceous glands. Two of the melanomas were diagnostically problematic because of suboptimal histopathology. Ilven inflammatory linear verrucous epidermal nevus, also known as ilven, is clinicopathological subgroup of epidermal nevus. Rarely invades cornea, appears in fornix or over palpebral conjunctiva rarely involves bulbar conjunctiva, caruncle, or plica semilunaris may be observed at birth or later may enlarge and become more pigmented at puberty or during pregnancy about half of excised pigmented lesions are nevi, remainder are melanomas or primary acquired melanosis.
Part 1 of my in progress video series about the pathology of melanocytic skin lesions. Distinction of conjunctival melanocytic nevi from melanomas by. Common terms, including mole, birthmark, and beauty mark, are used to describe nevi, but these terms do not distinguish. None of the conjunctival melanocytic nevi showed a level of chromosomal aberrations that met fish criteria for a diagnosis of melanoma. On account of the histological composition of the caruncle, which includes, in addition to conjunctiva, hair. Full text surgical management of a conjunctival nevus. Sebaceous nevus is a relatively common hamartoma that presents most often as a single congenital hairless plaque on the scalp. Histologic correlation of dermoscopy findings in a. Melanocytic nevi are the most com mon tumors of the conjunctiva, accounting for 28% of all tumors. Conjunctival nevi are benign hamartomatous tumors composed of modified melanocytes named nevus cells derived embryological from the neural crest. Histopathological study of lesions of the caruncle. The conjunctival tumor was resected, and an amniotic membrane transplantation was performed for the bulbar conjunctival reconstruction. Inflamed conjunctival nevi icn may suggest malignan cy because of their rapid growth and atypical histology. The aim of the study was to investigate the most common types of caruncle lesions.
None of the excised lesions showed histopathologically malignant features. A scoring method was developed based on histology and immunopathological parameters. Malignant cellular features consistent with melanoma were observed in some foci. Conjunctival nevus can be managed by periodic observation with photographic documentation or surgical resection, depending on tumor size, symptoms, features, and parental concerns. Conjunctival nevi in young individuals can correspond to the entity named inflammatory juvenile conjunctival nevus ijcn, presenting clinically as a rapid growth. The objective of this study was to characterize the diagnostic features of icn. Surgical techniques for conjunctival and corneal tumors.
However, the classification scheme differs in the conjunctiva because of differences in anatomy, prognosis, and management. Clinical features of pigmented conjunctival lesions. They can be classified into nevi congenital, which are present at birth or. The ozone layer is thinning and the incidence of conjunctival melanoma is increasing. Search for histopathological characteristics of inflammatory juvenile. This video discusses the basic features and patterns that are commonly seen in benign melanocytic nevi. Management of primary acquired melanosis, nevus, and. Evolution of conjunctival nevus into malignant melanoma is extremely low 1%. Immunohistochemical studies of atypical conjunctival. Melanocytic lesions of the conjunctiva have diverse clinical and histopathologic features. Conjunctival melanoma is a rare but potentially deadly ocular malignancy.
Conjunctival nevi in young individuals can correspond to the entity named inflammatory juvenile conjunctival nevus ijcn, presenting clinically as a rapid growth lesion, and showing at the histopathological study an inflammatory infiltrate surrounding the lesion. Page 3 tumors nevus a benign pigmented conjunctival tumor of the conjunctiva. These different types of tissues can give rise to a wide variety of lesions that make the clinical diagnosis difficult. Conjunctival melanoma is an uncommon malignancy with the potential for significant morbidity and mortality. A juvenile case of conjunctival atypical nevus diagnostic pathology. Although nevi are considered to be congenital lesions, they are often detected toward the end of the first decade of life. A conjunctival melanocytic nevus may on occasion be difficult to distinguish from melanoma both clinically and histopathologically. A clinical photo demonstrating heterochromic bulbar lesion with areas of deep melanosis. Ki67 was the most valuable immunohistochemical adjunct to morphology for the diagnosis of these benign variant conjunctival nevi, because melanomas display a much higher proliferation index 10% nuclear positivity among all cells counted than the current nevi approximately 1%. Conjunctival melanoma com constitutes about 2% of all ocular malignancies and 5% of all ocular melanoma. It is usually a discrete lesion on the conjunctiva the clear film over the eye and can range from dark brown to yellow color. The histopathologic diagnosis of a conjunctival nevus was confirmed in 105 lesions from 104 patients. A retrospective, nonrandomized study of patients with icn was conducted. Recentarticles about the conjunctival nevus have primarily focused on the histopathologicfeatures of this entity.
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