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Conjunctival melanosis - External and Internal Eye
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Conjunctival melanosis - External and Internal Eye

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Contributors: Brandon D. Ayres MD, Christopher Rapuano MD, Harvey A. Brown MD, Sunir J. Garg MD, Lauren Patty Daskivich MD, MSHS
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Synopsis

Primary acquired melanosis (PAM) of the conjunctiva presents as a unilateral, flat, patchy, non-cystic, and brown-pigmented lesion of the conjunctival epithelium. It is seen mostly in middle-aged, fair-skinned, and older, white patients. It is caused by the proliferation of atypical melanocytes in the epithelium that do not invade the subepithelial tissue unless there has been malignant transformation. Since it can occur in any part of the conjunctiva, it is important to examine the underside of the eyelid. This lesion can remain dormant for years or show slow progression. It is the most important precursor of conjunctival malignant melanoma with some 1–30% of cases following that course. There are no associated symptoms.

Codes

ICD10CM:
H11.139 – Conjunctival pigmentations, unspecified eye

SNOMEDCT:
91268007 – Conjunctival melanosis

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Racial melanosis – almost always bilateral
  • Conjunctival nevus – does not extend into cornea or fornices, may have very little pigmentation, and can have cysts
  • Secondary acquired melanosis – eg, foreign body, ciliary body melanoma, blood-filled cysts
  • Oculodermal melanocytosis (nevus of Ota) – mostly in blacks and Asians, unilateral, blue/gray color, and does not move with the conjunctival epithelium
  • Melanoma – growth and biopsy makes the diagnosis
  • Congenital melanocytosis – present at birth

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 01/20/2015
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Conjunctival melanosis - External and Internal Eye
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Conjunctival melanosis : Bulbar conjunctiva pigmented macule, Conjunctiva, Conjunctival pigmentation, Unilateral
Clinical image of Conjunctival melanosis
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