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. 2025 Sep 14;197(30):E958-E959.
doi: 10.1503/cmaj.250428.

Pigmented conjunctival lesions

Kelly Ann Hutchinson  1 , Alexa Fine  1 , Rachel Curtis  2
Affiliations

Pigmented conjunctival lesions

Kelly Ann Hutchinson et al. CMAJ. .
No abstract available

PubMed Disclaimer

Conflict of interest statement

Competing interests:: None declared.

Figures

Figure 1:
Figure 1:
A colour photograph of the right eye of a 35-year-old male with diffuse conjunctival pigment, present for many years, diagnosed as complexion-associated melanosis (CAM). This patient was referred to an ophthalmologist by an emergency physician and found to have diffuse conjunctival pigment in both eyes without clear areas of delineation and with a greater concentration at the limbus, most in keeping with CAM. This patient is followed annually by ophthalmology with serial photography of all areas of the conjunctiva, including eyelid eversion. Despite CAM rarely, if ever, transforming into conjunctival melanoma, it can coexist with primary acquired melanosis and be difficult to differentiate.
Figure 2:
Figure 2:
A colour photograph of a pigmented lesion in the right eye of a 31-year-old female, diagnosed clinically as a conjunctival nevus. The patient was referred to an ophthalmologist by an optometrist for evaluation of a stable pigmented lesion that had been noticed by the patient several years prior. On examination, a slightly elevated, well-circumscribed, temporal pigmented lesion measuring 4.5 mm in diameter was observed. Anterior segment optical coherence tomography was performed and corroborated the presence of intralesional cysts (also visible clinically on high magnification). Given the stability of the lesion and evidence of cysts, a finding associated with conjunctival nevi and not typically melanoma or primary acquired melanosis, the patient was offered the option of excision or continued monitoring; she has been followed regularly by ophthalmology with serial photography.
Figure 3:
Figure 3:
A colour photograph of the right eye of a 41-year-old female with a perilimbal pigmented lesion, clinically suspected to be primary acquired melanosis (PAM) and confirmed on histopathology. This patient was referred to an ophthalmologist by general ophthalmology for bilateral conjunctival pigmentation of unknown duration. The right eye, shown in the image, exhibited a flat, wedge-shaped area of pigmentation, most pronounced perilimbally, spanning 1.5 clock hours. Primarily owing to the size of the lesion and absence of concerning risk factors for conjunctival melanoma, the patient was given the option of careful serial observation versus an excisional biopsy. The patient opted for excision with cryotherapy; histopathology showed a diagnosis of PAM with severe atypia.
Figure 4:
Figure 4:
A colour photograph of a pigmented conjunctival lesion of the left eye of a 61-year-old male, diagnosed as melanoma on histopathology. The patient was referred to an ophthalmologist by an optometrist for evaluation of an enlarging conjunctival lesion that had been progressing over the past year. He had no prior history of cancer. On examination, the flat lesion spanned 2 clock hours, with scattered pigmentation involving the cornea, limbus, and conjunctiva, extending temporally. A conjunctival excision with cryotherapy and superficial keratectomy was performed. Histopathologic analysis confirmed the diagnosis. The patient was treated with adjunctive topical chemotherapy consisting of 4 cycles of mitomycin C (4 times daily for 1 week, followed by 3 weeks off), along with frequent lubrication and optional prednisolone 1%, in the event of ocular irritation or discomfort, up to 4 times daily throughout each cycle. Punctal plugs were placed in both the upper and lower puncta before initiating treatment to reduce the risk of punctal and canalicular stenosis and increase contact time of the chemotherapeutic agent on the ocular surface. He continues to be closely monitored in the ophthalmology clinic for signs of recurrence.
See this image and copyright information in PMC

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