Abstract
Conjunctival nevi are birthmarks, or hamartomas that typically become visible within the first decades of life. Their life cycle is assumed similar to cutaneous nevi. Nevi evolve from junctional collections of melanocytes to nests of melanocytes found in deeper layers of the substantia propria over time. Traditional teaching directs the risk of malignant transformation to junctional and compound nevi. Although the cumulative life-time risk of transformation is small, estimates are based on limited data. Pathologists use roughly a dozen histologic criteria to distinguish nevi from melanomas. Common conjunctival nevi have mutually exclusive mutations in BRAF and NRAS, suggesting similar driver mutations to cutaneous nevi rather than uveal. The Holy Grail of immunohistochemistry is to find a marker that distinguishes nevus from melanoma. The photograph gallery includes pathology of conjunctival nevi.
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