In black patients, the melanosis tends to be pigmented more deeply at the limbus and it then fans out, decreasing in intensity toward the fornix. They found 35% of the lesions to enlarge in size and 12% transformed into melanoma when clinically observed over a 10year period. Ophthalmic pearls oncology conjunctival pigmented lesions. C nevus shown as a slightly elevated pigmented lesion with intraepithelial cysts. A genuine malignant melanoma arising in an area of acquired melanosis of the conjunctiva carries. Melanosis is an inadequate and misleading term because it does not distinguish between conjunctival intraepithelial melanin overproduction hyperpigmentation and intraepithelial melanocytic proliferation. Melanocytic lesions clinically present as flat or nodular and it is in this way this. A complexion melanosis appearing as diffuse conjunctival pigmentation in a pigmented individual. Clinical features of benign vs malignant conjunctival. Conjunctival primary acquired melanosis is the most important precursor of conjunctival malignant melanoma. Pigmented lesions that arise from the conjunctiva include nevus, complexionassociated melanosis cam, primary acquired melanosis pam, and malignant melanoma.
Nasal mucosal melanosis may act as a harbinger of melanoma. For conjunctival intraepithelial neoplasia cin and invasive squamous cell carcinoma scc, surgical excision can be performed especially if there is a need to quickly manage the patient. Congenital melanosis definition of congenital melanosis. We illustrate the utility of combination topical therapy with adjunctive cryotherapy to treat extensive eyelid and conjunctival lesions. Amniotic membrane transplantation in the management of. Finger, md description malignant melanomas can start as a nevusfreckle or arise as newly formed conjunctival pigmentation called primary acquired melanosis pam. Choristomas form a minority of lesions in adults but are the second most common conjunctival tumors found in children after melanocytic tumors 5, 6. Four patients were given mmc for 28 days as a primary treatment. Mckelviemalignant melanoma of the lacrimal sac complicating primary acquired melanosis of the.
It is most often seen in the lower labial gingiva of tobacco users. In this condition, the melanocytes are increased in number but have a normal appearance and are in their normal location in the deepest layer of the epithelium. Conjunctival primary acquired melanosis pam is a painless flat brown spot on the eye that might superficially look like a freckle. Primary acquired melanosis of the conjunctiva pam is a potentially serious melanocytic lesion that can lead to the development of melanoma. Overview and classification of conjunctival and corneal. Dramatic regression of conjunctival and corneal acquired. A simple choristoma contains only one type of tissue, whereas a complex choristoma contains more than one type. B primary acquired melanosis manifesting as a discrete patch of conjunctival pigment.
Conjunctival pam is often precancerous and leads to lifethreatening malignant melanoma. For language access assistance, contact the ncats public information officer. A 66yearold woman was treated with excision and cryotherapy for recurrent primary acquired melanosis pam with atypia of the right conjunctiva. Aim to evaluate topical mitomycin c mmc chemotherapy in the treatment of conjunctival melanoma and primary acquired melanosis with atypia. In 1980, the who proposed the term pam to describe this disorder. A clinicopathologic study of 41 cases of primary acquired melanosis has provided information concerning the rate of progression to melanoma and has provided histologic parameters useful in predicting which lesions are likely to progress to malignant melanoma.
An internet ocular pathology archive, with permission from university of utah ophthalmic pathology. There are no published size criteria for the clinical diagnosis of pam, although in one large series pam extended for a mean of 3 clock hours, ranging from 1 to 12 clock hours. Topical mitomycin chemotherapy for conjunctival malignant. Full text surgical management of a conjunctival nevus. Primary acquired melanosis pam presents as a unilateral patchy area of conjunctival pigmentation mostly found in middleaged or elderly white patients. Combination topical therapy for conjunctival primary. Objectives to clinically evaluate topical mitomycin chemotherapy in patients with diffuse, multifocal, or recurrent primary acquired melanosis with atypia andor conjunctival malignant melanoma and to histopathologically study ocular tissue samples obtained before and after treatment methods chemotherapy with topical mitomycin, 0. Genetic and rare diseases information center gard po box 8126, gaithersburg, md 208988126 tollfree. Conjunctival melanoma arising from primary acquired. Most easily it is found in caucasians, due to their lack of. Surgical techniques for conjunctival and corneal tumors. If you have problems viewing pdf files, download the latest version of adobe reader. Primary acquired melanosis the term primary acquired melanosis pam was adopted by the world health organization in 1980 representing flat, brown.
Cam, also known as racial melanosis, is a benign lesion found among darkly pigmented individuals. This paper aims to stimulate debate on the terminology, classification, grading and staging of conjunctival melanosis and melanoma. Pam appears as unilateral, patchy areas of flat, brown pigmentation within the superficial conjunctiva. View the article pdf and any associated supplements and figures for a period of 48 hours. It is recommended that intraepithelial melanocytic proliferation be adopted for histopathologic diagnosis. This definition includes the ephelis or freckle, so called complexionassociated conjunctival pigmentation, and benign acquired melanosis because the three entities may be indistinguishable clinically and under the microscope. It can be clinically confused with more common conditions, such as conjunctival nevus or primary acquired melanosis. It is analagous to lentigo maligna of the skin and carries a risk of malignant transformation. A2 excellent cosmetic and functional result at 8 weeks. Nevi of the conjunctiva are usually benign pigmented. Primary acquired melanosis appears clinically as a flat and variably brown conjunctival lesion, ranging from golden brown to dark chocolate in color figs. Sinonasal melanoma arising from conjunctival primary. The process is acquired after birth and generally in adulthood. It can be found in children and adults and typically occurs on only one eye.
Conjunctival tumors can display either benign or malignant features. This brown pigmentation is flat and irregular and can occur anywhere in the conjunctival or corneal epithelium. Methods in a phase i clinical trial, 10 patients with conjunctival melanoma andor primary acquired melanosis with atypia were treated with topical mmc 0. Topical mitomycin c chemotherapy for conjunctival melanoma. Figure 1 a1 preoperative view of a nodular,deeply pigmented conjunctival malignant melanoma arising in the context of primary acquired melanosis and a naevus in the temporal epibulbar quadrants of the left eye in a 49 year old man case 1. Because pam has the potential of becoming malignant, it is important to recognize pam and to rule out other causes of pigmented lesions. Any conjunctival cell type can potentially lead to one or more particular conjunctival tumors.
She was treated with right medial maxillectomy and postoperative radiation therapy. Four years later, she developed a melanoma of the ipsilateral inferior turbinate and nasolacrimal duct. For papillomas, excisional biopsy and cryotherapy using the no touch technique with or without adjuvant oral cimetidine andor topicalinjection interferon alfa2b provides satisfactory tumor control. Smokers melanosis is seen with the naked eye as a brown to black pigmentation of the oral tissue i. Reprinted from university of utah, peter debry, kwok li, and nick mamalis, md, ophthalmic pathology. Conjunctival primary acquired melanosis wills eye hospital. This is the first reported case of conjunctival pam. Conjunctival melanosis now differentiated histologically into hypermelanosis and conjunctival melanocytic intraepithelial neoplasia cmin cases formerly classified as pam are now classified as cmin.
Several types of naevi can be identified in the conjunctiva, with some sitespecific peculiarities, familiarisation with which. Pigmentation of the basal layer of the epithelium without a proliferation of melanocytes. We audited our results with 76 invasive conjunctival melanomas. Conjunctival melanosis and melanoma robert folberg, md ian w. As seen below, primary acquired melanosis typically affects one eye, in. Conjunctival choristoma is a tumor composed of tissues not normally present in the conjunctiva. To report the case of a patient who initially presented with primary acquired melanosis pam without atypia of the conjunctiva and later developed lentigo maligna of the eyelids and pam with atypia of the conjunctiva. Who classification has been most widely used and includes three pathologic categories. In 2008, we suggested that it would be more precise for histopathologists to differentiate between conjunctival melanocytic intraepithelial neoplasia cmin and.
Conjunctival melanocytic nevi are similar to those occurring in the skin and are benign, acquired or congenital, circumscribed melanocytic proliferations. Primary acquired melanosis of the conjunctiva sciencedirect. This conjunctival melanoma likely developed from primary acquired melanosis pam with atypia and then grew onto the superficial surface of the cornea. He explained everything i needed to know about my issue with detail and attention, putting me at ease and giving me confidence to. Conjunctival melanoma is a rare but potentially deadly ocular malignancy. Primary acquired melanosis pam is an acquired pigmentation of the conjunctival epithelium. Clinical features of pigmented conjunctival lesions. Conjunctival melanocytic intraepithelial neoplasia clinical features patients with cmin present in adulthood with a unilateral area of conjunctival melanosis synonymous pam figure 2 28,29. However, a number of other lesions have a similar appearance but a different source, such as pigment deposits from silver and iron. In contrast, the concept of conjunctival melanosis and the restricted use of the term melanoma to. Management of primary acquired melanosis, nevus, and. What is primary acquired melanosis of the conjunctiva.
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