Which clinical history findings are characteristic of conjunctival melanoma?

Updated: Feb 16, 2021
  • Author: Manolette R Roque, MD, MBA, FPAO; Chief Editor: Hampton Roy, Sr, MD  more...
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Eliciting a good history of the growth characteristics of each lesion is important in patients with conjunctival melanomas. The well-informed patient often is aware of subtle changes that may be crucial in identifying these lesions.

Melanomas that arise without a preexisting conjunctival nevus are usually at the limbus and are believed to initially have a short horizontal growth phase followed by a rapid vertical growth phase.

Melanomas that arise in a preexisting nevus are often characterized by growth of the lesion or by increased vascularity.

Any nevus that has increased in vascularity, size, or solidity or that has become fixed to the underlying sclera (nevi are always freely movable over the sclera, except at the fixation point at the limbus) should be suspected of being a malignant melanoma.

In the case of primary acquired melanosis, the onset of malignant degeneration is often heralded by the development of nodular thickening in a previously flat area of pigmentation. Other noteworthy features of malignant degeneration include increased vascularity, fixation of the conjunctiva to the underlying sclera, and hemorrhage.

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