Which physical 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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The clinical presentation of conjunctival melanoma can vary and depends on the antecedent status of the conjunctiva. A melanoma can be distinguished from primary acquired melanosis by its tendency to become fixed to the underlying tissues, which is not a feature of primary acquired melanosis.

In managing patients with conjunctival melanoma, 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.

Conjunctival melanomas may extend onto the peripheral limbus. Most melanomatous nodules at the limbus affect the peripheral cornea; some grow circumferentially around the limbus. Rarely, a melanomatous nodule may be located more centrally in the cornea.

Pigmentation of the eyelid margins and skin occasionally accompanies primary conjunctival melanomas, particularly those located on the palpebral conjunctiva and fornix; this combined presentation discloses a poorer prognosis.

Other uncommon manifestations include poliosis.

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