J Korean Ophthalmol Soc.  2010 May;51(5):764-768.

Surgical Treatment of Extensive Conjunctival Melanocytic Nevus Mimicking Conjunctival Melanoma

• Jo DH
• Lee MJ
• Han YK
• Kwon JW

Abstract

PURPOSE
To report a case of diffuse conjunctival melanocytic lesion mimicking conjunctival melanoma and treated by surgical excision and amniotic membrane transplantation.
CASE SUMMARY
A 29-year-old man presented with diffuse pigmented lesion on the bulbar conjunctiva in the right eye, which had been present since birth. Circumferential pigmentation was observed in the perilimbal conjunctiva from 4 to 11 o'clock, and slightly elevated, dark brown-colored lesions with multiple small cysts were noted on the superior, inferior, and temporal bulbar conjunctiva. Incisional biopsy was performed from multiple sites to rule out conjunctival melanoma. Histopathologic examination showed small nevus cells and multiple cysts. Under local anesthesia, temporal conjunctival excision and amniotic membrane transplantation were performed. The surgical pathologist confirmed compound nevus. Four weeks after the surgery, full epithelialization was observed over the amniotic membrane. Several lesions were intentionally left during the surgery, and unnoticeable from the frontal view. The patient was satisfied with the surgical result.
CONCLUSIONS
In extensive conjunctival pigmented lesion, biopsy should always be performed to rule out melanoma. Temporal conjunctival excision rather than whole lesion excision can be a cosmetically good surgical option for a diffuse conjuntival lesion proven as a benign conjunctival nevus.

Keyword

Malignant melanoma; Melanocytic nevus

MeSH Terms

Adult
Amnion
Anesthesia, Local
Biopsy
Conjunctiva
Eye
Humans
Intention
Melanoma
Nevus
Nevus, Pigmented
Parturition
Pigmentation
Transplants

Figure

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  Figure 1. Circumferential pigmentation was observed on the limbus from 4 to 11 o'clock, and slightly elevated, dark brown-colored lesions with multiple small cysts were noted on the superior (Top left), inferior (Top right), and temporal (Bottom left) bulbar conjunctiva. On the slitlamp examination, the lesions were proved to be slightly elevated (Bottom right).

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  Figure 2. Compared with the preoperative photograph (A) the postoperative photograph (B) showed no noticeable pigmented lesion on the front view.

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  Figure 3. Histopathologic examinations showed that multiple nests of nevus cells and several stromal cysts. (A) ×200, (B) ×400.

Reference

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