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| conjunctival_pigmented_lesions [2026/02/25 19:21] – [Table] Scott Larson | conjunctival_pigmented_lesions [2026/02/25 19:50] (current) – Scott Larson | ||
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| ====== Conjunctival Pigmented Lesions ====== | ====== Conjunctival Pigmented Lesions ====== | ||
| - | FIXME | + | |
| ====Nevi==== | ====Nevi==== | ||
| * Usually appear in childhood | * Usually appear in childhood | ||
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| ===Complexion Associated Melanosis (CAM)=== | ===Complexion Associated Melanosis (CAM)=== | ||
| + | * Bilateral perilimbal pigmentation in darkly pigmented inviduals | ||
| + | * Doesn' | ||
| ===Primary Acquired Melanosis (PAM)=== | ===Primary Acquired Melanosis (PAM)=== | ||
| + | * Usually seen in fair skinned middle aged or older | ||
| + | * flat, unilateral, patchy, golden yellow or brown area, which may extend onto the cornea or corneal may similarly be involved. | ||
| + | * PAM with atypia can progress to melanoma | ||
| + | * PAM without atypia is low to no risk of transformation | ||
| + | * Treatement | ||
| + | * smaller lesions can be monitored, watching for nodularity, thickening, vascularity | ||
| + | * if changes or larger lesion, excision is recommended | ||
| + | * Excision | ||
| + | * Margins 4-5 mm | ||
| + | * Double freeze-thaw slow cryotherapy applied to the conjunctival edges | ||
| + | * For corneal PAM, apply absolute alcohol for one minute then epitheliectomy | ||
| + | * For diffuse disease or tarsal conjunctiva | ||
| + | * Cryotherapy with double freeze-thaw | ||
| + | * Topical interferon alpha-2b | ||
| + | * Topical mytomycin C 0.02% or 0.04% | ||
| + | * QID x 1 week | ||
| + | * Pause 1-2 weeks | ||
| + | * then QID x 1 week | ||
| + | * Repeat above until the pigment resolves, usually for 2-3 cycles | ||
| + | * punctual plugs placed before treatment | ||
| + | * use artificial tears and topical steroids for corneal toxicity | ||
| ===Malignant Melanoma=== | ===Malignant Melanoma=== | ||
| + | * Patients are usually 60-70 years old | ||
| + | * Limbus most common but can appear in the caruncle, tarsus or fornix | ||
| + | * Raised mass with feeder vessels | ||
| + | * Treatment | ||
| + | * Avoid incisional biopsy to prevent tumor seeding | ||
| + | * Excision with dry no-touch technique with margins of 4-6 mm | ||
| + | * Cryotreatment to conjunctival edges with double freeze-thaw | ||
| + | * Absolute alcohol to corneal lesions with | ||
| + | * Sclerectomy may be needed for tumors adherent to the sclera applying cautery and cryotherapy to the base | ||
| + | * Closure with primary closure or amniotic graft to cover the defects | ||
| + | * Sentinel node biopsy should be considered for lesions larger than 2 mm or high risk features on histopathology | ||
| + | * Prognosis | ||
| + | * Local recurrence 45% at 5 years and 59% at 10 years | ||
| + | * Mortality: 5-17% at 5 years- 9-35% at 10 years | ||
| + | * Denovo lesions have worst prognosis | ||
| + | * Poorer survival: older age, male, non-white, tumors with nodularity or ulceration. | ||
| ====Summary Table==== | ====Summary Table==== | ||
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| ====Resources==== | ====Resources==== | ||
| - [[https:// | - [[https:// | ||
| + | - [[https:// | ||
| + | - [[https:// | ||