Etiology Unclear

Symptoms: Acquired conjunctival melanosis usually occurs after the age of 40. Typical symptoms include irregular diffuse pigmentation and thickening of the epithelium that may "come and go."

Diagnostic considerations: Acquired conjunctival melanosis is mobile with the conjunctiva (an important characteristic that distinguishes it from congenital melanosis). It requires close observation with follow-up examinations every six months as it can develop into a malignant melanoma.

Differential diagnosis: This disorder should be distinguished from benign congenital melanosis (see below), which remains stable throughout the patient's lifetime and appears more bluish gray than brownish. In contrast to acquired melanosis, it is not mobile with the conjunctiva. Lang, Ophthalmology © 2000 Thieme

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Differential diagnosis of pigmented conjunctival changes.

Differential diagnosis of pigmented conjunctival changes.

Figs. 4.24a-j a Pigmented conjunctival nevus.

b Unpigmented conjunctival nevus.

c Primary acquired melano-

Figs. 4.24a-j a Pigmented conjunctival nevus.

b Unpigmented conjunctival nevus.

c Primary acquired melano-

Continued -

110 4 Conjunctiva Differential diagnosis of pigmented conjunctival changes.

Fig.4.24d Congenital melanosis.

e Malignant con-

junctival melanoma.

Fig.4.24d Congenital melanosis.

e Malignant con-

junctival melanoma.

f Malignant melanoma of the ciliarybody penetrating beneath the conjunctiva.

Differential diagnosis of pigmented conjunctival changes.

Differential diagnosis of pigmented conjunctival changes.

Fig. 4.24g Metallic foreign body that has healed within the conjunctiva.

h Adrenochrome deposits (from eyedrops containing epinephrine).

i Iron deposits from make-up (mascara)

Fig. 4.24g Metallic foreign body that has healed within the conjunctiva.

h Adrenochrome deposits (from eyedrops containing epinephrine).

i Iron deposits from make-up (mascara)

Continued -

— Differential diagnosis of pigmented conjunctival changes.

— Differential diagnosis of pigmented conjunctival changes.

Treatment: Because the disorder occurs diffusely over a broad area, treatment is often difficult. Usually it combines excision of the prominent deeply pigmented portions (for histologic confirmation of the diagnosis) with cryo-coagulation of the adjacent melanosis and in some cases with postoperative radiation therapy.

Clinical course and prognosis: About 50% of conjunctival melanomas develop from conjunctival melanosis (the other 50% develop from a conjunctival nevus; see above). Conjunctival melanomas are not usually as aggressively malignant as skin melanomas. The radical resection required to remove the tumor can be a problem. Multiple recurrences will produce significant conjunctival scarring that can result in symblepharon with fusion of the eyelid skin and conjunctiva. Where the tumor has invaded the eyelids or the deeper portions of the orbit, orbital exenteration will be unavoidable to completely remove the tumor.

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