Answer
Malignant melanoma of the conjunctiva presents as a raised pigmented or nonpigmented lesion. [1]
This lesion is uncommon but potentially lethal. It can arise in previously unblemished and unpigmented regions (approximately 10% of cases), from a preexisting nevus (approximately 20% of cases), or from the flat, spreading pigmentation of primary acquired melanosis with atypia (60-70% of cases).
Conjunctival melanomas may be associated with primary acquired melanosis (75%) or may arise from a preexisting nevus or de novo. Reprinted from University of Utah, Peter DeBry, Kwok Li, and Nick Mamalis, MD, Ophthalmic Pathology: An Internet Ocular Pathology Archive, with permission from University of Utah Ophthalmic Pathology.
Conjunctival melanoma. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye & Ear Infirmary, Boston, MA.
Conjunctival melanoma. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye & Ear Infirmary, Boston, MA.
Tarsal conjunctival melanoma. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye & Ear Infirmary, Boston, MA.
Invasive conjunctival melanoma. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye & Ear Infirmary, Boston, MA.
In addition to spreading by lymphatics and the bloodstream, conjunctival melanoma can undergo direct extension to the eyeball and orbit. [2]
The most frequent site of metastasis is the lung, followed by the liver, brain, and bone. In managing these patients, it is important to palpate the regional lymph nodes because spread to the ipsilateral preauricular, submandibular, and cervical nodes from the conjunctival sac is well recognized. Cohen et al reported an isolated gastric metastasis from a conjunctival melanoma. [3] Gastric metastases are frequently seen in cutaneous melanoma.
Go to Ciliary Body Melanoma, Choroidal Melanoma, and Iris Melanoma for complete information on these topics.
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Conjunctival melanomas may be associated with primary acquired melanosis (75%) or may arise from a preexisting nevus or de novo. Reprinted from University of Utah, Peter DeBry, Kwok Li, and Nick Mamalis, MD, Ophthalmic Pathology: An Internet Ocular Pathology Archive, with permission from University of Utah Ophthalmic Pathology.
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Dysplastic melanocytes may invade beyond the epithelium into the substantia propria or into the globe or lids. Reprinted from University of Utah, Peter DeBry, Kwok Li, and Nick Mamalis, MD, Ophthalmic Pathology: An Internet Ocular Pathology Archive, with permission from University of Utah Ophthalmic Pathology.
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Conjunctival melanoma. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye & Ear Infirmary, Boston, MA.
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Conjunctival melanoma. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye & Ear Infirmary, Boston, MA.
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Tarsal conjunctival melanoma. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye & Ear Infirmary, Boston, MA.
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Conjunctival nevus. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye & Ear Infirmary, Boston, MA.
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An aggressive conjunctival melanoma with lid involvement. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye & Ear Infirmary, Boston, MA.
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Large conjunctival melanoma that has invaded the orbit. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye & Ear Infirmary, Boston, MA.
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Histologic findings of invasive melanoma cells may be small polyhedral, epithelioid, spindled, or ballooned. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye & Ear Infirmary, Boston, MA.
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Conjunctival melanomas. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye & Ear Infirmary, Boston, MA.
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Invasive conjunctival melanoma. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye & Ear Infirmary, Boston, MA.
