Conjunctival melanoma can mimic ocular surface squamous neoplasia

Conjunctival melanoma can mimic ocular surface squamous neoplasia


Cornea/External Disease, Ocular Pathology/Oncology


The authors present 4 cases of conjunctival melanoma mimicking ocular surface squamous neoplasia.

Study design

Between 2011 and 2019, 4 patients were referred to the ocular oncology service of Moorfields Eye Hospital with suspected conjunctival squamous neoplasia. Researchers performed excisional biopsy with double freeze-thaw cryotherapy and alcohol keratoepitheliectomy.

Outcomes

All the patients had lesions in a perilimbal location and with involvement of the corneal surface. Two cases were nonpigmented and 2 had mild pigmentation. Three cases had a fleshy appearance, and 1 appeared papillomatous.

Histopathology confirmed that all 4 cases were invasive conjunctival melanoma. All patients received adjuvant therapy of strontium-90 beta radiotherapy, and 2 were treated with mitomicyn C.

Limitations

This is a small case series describing only 4 patients.

Clinical significance

Patients tend to be treated for conjunctival squamous neoplasm without confirmation. Clinical impressions of perilimbal nonpigmented conjunctival lesions that seem like ocular surface squamous neoplasia—absence of pigmentation, fleshy or papillomatous appearance, cork-screw vascularity and superficial appearance—need histopathological confirmation to rule out invasive conjunctival melanoma, which can present atypically in 30% of cases.