Pigmented conjunctival squamous cell carcinoma simulating a conjunctival melanoma.

PURPOSE: To report a pigmented conjunctival squamous cell carcinoma that clinically simulated a conjunctival melanoma. DESIGN: Interventional case report. METHODS: Ocular examination, surgical excision, and clinicopathologic correlation. RESULTS: A 78-year-old white man developed a lightly pigmented mass at the temporal limbus of his right eye. The differential diagnosis included pigmented squamous cell carcinoma and malignant melanoma. Histopathologic examination revealed a malignant squamous cell tumor that contained foci of melanin pigment. The final diagnosis was pigmented conjunctival squamous cell carcinoma. CONCLUSION: Conjunctival squamous cell carcinoma may rarely be pigmented and simulate a conjunctival melanoma.     

Postsurgical hematic cyst simulating a conjunctival melanoma

A 75-year-old man had undergone bilateral intracapsular cataract extraction and then a scleral buckling procedure for an aphakic retinal detachment in the right eye. He presented 15 years later with a dark brown mass in the superior fornix of his right eye. On the basis of the clinical findings, the diagnosis of a conjunctival melanoma was considered. The lesion was surgically excised and found to be a chronic hematic cyst that arose adjacent to a episcleral sponge placed at the time of retinal detachment surgery. Hematic cysts should be included in the differential diagnosis of pigmented conjunctival lesions.     

Localized conjunctival argyrosis: a late sequela of strabismus surgery

We describe a case of focal argyrosis of the conjunctiva clinically simulating a melanoma. An 82-year-old woman was referred for an asymptomatic pigmented conjunctival lesion. Her only significant past ocular history was strabismus surgery 76 years earlier. Biopsy of the conjunctiva and lateral rectus muscle revealed the discoloration was pigment granules. Energy-dispersive x-ray microanalysis revealed the pigmentation to be silver deposits. The patient had strabismus surgery probably using a silver clip. Argyrosis should be considered in the differential diagnosis of focal pigmented conjunctival lesions.     

Advanced conjunctival melanoma

BACKGROUND: Conjunctival melanoma is a rare neoplasm with an aggressive behaviour characterized by a high tendency to develop recurrences and metastases. The authors describe the clinicopathological features of four Mexican patients with advanced conjunctival melanoma. METHODS: Review of the cases of four patients with advanced conjunctival melanoma seen at an ophthalmologic referral centre in Mexico City. The clinical characteristics, gross findings and histopathological features were noted. RESULTS: The mean age of the patients (two women and two men) was 72 years (range 49 to 95 years).The left eye was affected in three cases and the right eye in one. Orbital exenteration was performed in two patients, enucleation in one and complete excision of the mass in one. One patient died 2 years after debulking surgery, and another patient is alive and free of disease 13 years after enucleation; the two other patients were lost to follow-up.The mean largest mass dimension of the tumours was 4 cm (range 3-5.4 cm). Histopathologically, all cases were associated with primary acquired melanosis with atypia. Two cases were composed of epithelioid cells, one of spindle cells, and one of a mixture of epithelioid and spindle cells. In three cases the number of mitotic figures ranged from 3 to 36/10 high-power fields; no mitotic activity could be demonstrated in one case. INTERPRETATION: The mean age of our patients at the time of diagnosis was older and their tumours were larger than those reported in other series. All the cases were associated with primary acquired melanosis with atypia. At the time of writing, one patient, who had a 3.3-cm tumour, had survived 13 years without clinically detectable disease.     

Unilateral conjunctival inflammation resembling a neoplasm

An 11-year-old black girl with excessive tissue growth from the conjunctiva and adjacent tissue, of several years' duration, was treated with excision of the tissue and topical steroids. Histopathologic examination revealed eosinophilic and plasma cell infiltration with a few lymphocytes and polymorphonuclear cells. Proliferation of the capillary endothelium was also noted. To our best knowledge, this type of inflammatory reaction of the anterior aspects of the globe has not yet been reported.     

Eyelid and conjunctival paracoccidioidomycosis simulating carcinoma

Paracoccidioidomycosis (PCM) is the most prevalent systemic mycosis in immunocompetent individuals in Brazil. Ocular infection by PCM is rare; however, when infection does occur, the most common ocular sites involved are eyelid and conjunctiva. A 68-year-old white male presented with a 2-month history of a painless, ulcerated, infiltrative and diffuse whitish lesion located on the right inferior eyelid. A clinical diagnosis of malignant tumor, possibly squamous cell carcinoma, was made. The histopathologic examination showed a hyperplastic epithelium with inflammatory infiltrate of lymphocytes, plasma cells, neutrophils and histiocytes. Large numbers of giant cells were also present. Periodic acid Schiff and Grocott (silver methenamine) stains showed several large round structures with peripheral lateral small budding cells that resembled a “ship’s wheel”. No multinucleated fungi were seen. The fungi varied in size and small forms were round and single fungal structures. A diagnosis of paracoccidioidomycosis was made PCM eyelid infection is rare and can simulate carcinoma both clinically and histopathologically.     

Clinical aspects of conjunctival melanoma

Conjunctival melanoma is a rare but important condition encountered in ophthalmology. This paper reviews conjunctival melanoma as a clinical entity, with particular emphasis on differential diagnosis, management and prognostic factors. Relevant references were located through a comprehensive search of articles published between 1980 and early 2001 on Medline, using both the WinSpirs and PubMed platforms. The references of these articles were then checked for further articles of relevance. The condition is uncommon and its presentation variable; therefore, relevant studies were found to suffer from small numbers of subjects. This may be the cause of the confusion that still surrounds the condition and its management.     

BRAF mutations in conjunctival melanoma

PURPOSE: An activating mutation in exon 15 of the BRAF gene has been found in a high proportion of cutaneous melanomas and cutaneous nevi but not in uveal melanoma. Conjunctival melanoma shows greater clinical similarity to cutaneous melanoma than does uveal melanoma. The purpose of this study was to determine whether the T1799A BRAF mutation found in cutaneous melanoma is also present in conjunctival melanoma. METHODS: DNA was extracted from paraffin sections obtained from glutaraldehyde or formalin-fixed, paraffin-embedded conjunctival melanomas. Forty-two specimens were identified from 25 patients. Seminested PCR was used to amplify exon 15 of the BRAF gene, and the resultant PCR product was purified and directly sequenced. Sequences from conjunctival melanomas were compared with the wild-type sequence of the BRAF gene. The presence or absence of the BRAF mutation was compared with the clinicopathological features. RESULTS: The T1799A (V600E) mutation was detected by sequencing in melanomas from 5 of 22 patients as well as in the positive control, a cutaneous melanoma cell line. In this small series, no statistically significant associations between the presence of the BRAF mutation and clinicopathological characteristics were detected, although tumors with this mutation tended to have a larger diameter and greater depth of invasion and to contain epithelioid cells. CONCLUSIONS: Others have demonstrated a BRAF T1799A-activating mutation in cutaneous but not uveal melanoma. In this study, this BRAF mutation was demonstrated in some conjunctival melanoma tissue samples, suggesting that some conjunctival melanomas may share biological features in common with cutaneous melanoma.     

Local metastasis in conjunctival melanoma

After excision of conjunctival melanomas the rate of recidivation is high. This may partly be due to local seeding of tumour cells in the excision wound, as we observed in one patient. We now use a sodiumhypochlorite solution (Dakin's solution) as tumour cell killing agent. Instead of diagnostic biopsy exfoliative cytology is performed; at surgery the tumour is not touched except for cauterisation with formaldehyde.     

结膜黑色素瘤的研究进展

结膜黑色素瘤（conjunctival melanoma,CM）是一种罕见的肿瘤,其相关死亡率为30%,在结膜恶性肿瘤中预后最差。CM由结膜上皮基底层的黑色素细胞恶变而来,在此之前可见相应结膜的色素性病变如原发性获得性黑变病及结膜色素痣,最常见于球结膜或角巩膜缘,也可出现于睑结膜。CM能向眼球或眼眶侵袭,并可向局部淋巴结、脑及其他器官转移。组织病理学检查为诊断本病的金标准。多数CM可通过手术切除,术后联合辅助治疗可降低局部复发及远处转移的风险。（国际眼科纵览,2020,  45：386-392）     

Unilateral conjunctival ulcer due to Stenotrophomonas maltophilia infection

We report a case of unilateral conjunctival ulcer due to Stenotrophomonas maltophilia infection in an immunocompetent individual. A 44-year-old male presented with complaints of pain and yellowish discharge in the right eye for one week. Patient underwent complete ophthalmic evaluation and relevant laboratory investigations. Anterior segment examination revealed localized conjunctival and episcleral congestion with conjunctival ulceration on the bulbar conjunctiva in the right eye. Gram's stain revealed gram-negative bacilli. Culture and sensitivity revealed S. maltophilia and responded well to topical moxifloxacin with systemic co-trimoxazole therapy.     

Late manifestation of conjunctival malignant melanoma

The patient, who is now 60, had a nevus and areas of cystic changes in the conjunctiva in her right eye, which had been present from birth to the age of 59. In 1987, rapid tumor growth aroused suspicion that malignant change could be occurring and so the nevus as well as the area of the conjunctiva containing cystic changes were excised. Histological finding: conjunctival malignant melanoma, containing compressed (densely arranged) atypical cells with pleomorphic hyperchromatic nuclei and prominent nucleoli. The biopsy specimen of the conjunctiva showed a typical nevocellular nevus with large inclusion cysts of the conjunctival epithelium.     

Clinical follow-up of conjunctival malignant melanoma

PURPOSE: To investigate the clinical features and course of conjunctival malignant melanoma in Korea. METHODS: The medical records of 15 patients, 5 males and 10 females, diagnosed with conjunctival malignant melanoma who had been treated at Severance Hospital from May 1991 to March 2004 were reviewed retrospectively. The clinical parameters of the patients, tumors, and treatment were analyzed for their relation to outcome measures. RESULTS: The mean age at the time of diagnosis was 53.4 years (+/- 11.7 years). In all cases, the disease was unilateral and all patients had experienced at least one recurrence. Local lymph node metastasis was found in 3 patients (20%) and the mean time to metastasis was 3.5 years. Systemic metastasis was found in 6 patients (40%) and the mean time to metastasis was 9.3 years. There were 5 cases of tumor-related death (33.3%), 4 of which were attributed to systemic metastasis. The Kaplan-Meier estimates of cumulative survival rate were 90% at 30 months and 56.6% at 70 months. CONCLUSIONS: Although conjunctival malignant melanoma is a rare disease, it is life-threatening and complete tumor excision at an early stage is mandatory, as is additional therapy to prevent local recurrence and systemic metastasis.