Conjunctival Nevi Research Articles

Search for histopathological characteristics of inflammatory juvenile conjunctival nevus in conjunctival nevi related to age: Analysis of 33 cases

PurposeConjunctival nevi in young individuals can correspond to the entity named Inflammatory Juvenile Conjunctival Nevus (IJCN), presenting clinically as a rapid growth lesion, and showing at the histopathological study an inflammatory infiltrate surrounding the lesion. All these findings can suggest a diagnosis of malignancy. Due to a case of IJCN diagnosed in our Pathology department, we realized that this entity is rarely reported in the literature and histopathological diagnostic criteria are not well defined. The aim of our study is to compare the histopathological characteristics of conjunctival nevi in patients aged thirty years or less to those in patients above 30 years, looking for the findings described in IJCN. MethodsAll the excisional specimens of resected conjunctival nevus in a tertiary hospital from 2000 to 2018 were retrieved from the Pathology department archives. Demographic data were recorded, and histopathological variables (histological type of nevus, lymphocytic infiltration, eosinophilic infiltration, presence of lymphoid follicles, stromal nevomelanocytic component, intraepithelial nevomelanocytic component, epithelial inclusions, quantity of goblet cells in epithelial inclusions, cellular atypia, mitoses and maturation of the lesion) were evaluated by three independent observers. Statistical analysis was performed comparing the two age groups. ResultsThe study determined a significant predominance of the lymphocytic and eosinophilic infiltration in the group of patients aged thirty years or less respect to the elderly group. The percentage of stromal component of the lesion is larger in patients over thirty years compared to the younger group. There was no correlation between epithelial inclusions, maturation or cytological atypia and age groups. ConclusionWe found some histopathological differences in conjunctival nevi related to young age, some of them coincident with the ones described in IJCN, which histopathologically could lead to a misleading diagnosis. However, we did not find significant differences related to age in many of the described histopathological findings described in IJCN. Larger series with a greater number of cases would be of interest to characterize more precisely this lesion.

Conjunctival Melanoma in Asian Indians: A Study of 42 Patients

ABSTRACTPurpose: To describe the clinical features, treatment, and outcomes of conjunctival melanoma in Asian Indians.Methods: Retrospective study of 42 patients.Results: The mean age at presentation of conjunctival melanoma was 43 years (median, 45 years; range, 9–78 years). There were 20 (48%) males and 22 (52%) females. Nineteen patients (45%) had a known history of a preexisting pigmented conjunctival lesion. Bulbar conjunctiva (n = 28; 67%) was the most common tumor epicenter, and medial ocular surface quadrant (n = 15; 36%) was more commonly involved. The mean tumor basal diameter was 12 mm (median, 10 mm; range, 4–30 mm), and the mean tumor thickness was 4 mm (median, 2 mm; range, 1–30 mm). Majority of the patients had a pigmented tumor (n = 33; 79%). The tumors arose de novo (n = 17, 41%) or were associated with conjunctival nevus (n = 9; 21%) or primary acquired melanosis (n = 16, 38%). Wide excisional biopsy, adjunctive cryotherapy, and amniotic membrane grafting were performed in 27 (71%) patients, 11 (29%) underwent orbital exenteration, and 4 were lost to follow-up prior to definitive treatment. Over a mean follow-up period of 24 months (median, 9 months; range, <1 to 136 months), four (11%) patients had tumor recurrence, seven (18%) had locoregional lymph node metastasis, and four (11%) developed systemic metastasis and died due to metastatic disease.Conclusion: Conjunctival melanoma predominantly occurs in middle-aged Asian Indians and is associated with a high rate of systemic metastasis and death.

Melanocytoma of the Conjunctiva: Clinicopathologic Features of Three Cases

Background: Melanocytoma (magnocellular nevus) is a jet-black benign lesion histologically composed of polygonal tumor cells with small, inconspicuous nuclei and abundant cytoplasm. Melanocytomas in general are rare. Most cases occur in the optic nerve head. Conjunctival melanocytoma (magnocellular nevus) is extremely rare, and only 3 lesions of the ocular surface have been reported. Objectives: To describe the clinical and histological spectrum of conjunctival melanocytoma and discuss differential diagnoses of this rare lesion. Method: Four heavily pigmented conjunctival lesions were excised for slight tumor growth and histologically processed. The specimens were routinely stained with hematoxylin and eosin and periodic acid-Schiff. Sections were bleached and immunohistochemical stains were performed for CD68, HMB-45, S100, melanin, and Ki-67. Results: Histological examination revealed findings of a conjunctival melanocytoma in 3 cases. The fourth case was diagnosed histologically as a combined melanocytic lesion with a compound nevus and an inverted type A nevus. None of the lesions exhibited transition towards malignancy. The differential diagnoses included conjunctival melanoma, granular cell nevus, compound nevus with reactive changes, and blue nevus. Conclusions: Conjunctival melanocytic lesions suspicious for melanocytoma should be bleached to evaluate their cytologic features. CD68 can be helpful in identifying heavily pigmented melanomacrophages which may mimic a melanocytoma. As conjunctival melanocytomas are extremely rare, their pathogenesis may be different from that of other conjunctival nevi.

The Amazon Ocular Oncology Center: The first three years.

To evaluate the first three years of The Amazon Ocular Oncology Center, the first ocular cancer center in the North of Brazil. Here, we report patient information including patients' age, gender, diagnosis, treatment, and city of origin. Two hundred and twenty-one patients were included on this study: 160 (72%) patients came from the city of Manaus, 52 (24%) from other cities in Amazonas, and 9 (4%) from other states. Of the 221 patients, 150 (68%) were afflicted with benign lesions and the remaining 71 (32%) had malignant lesions. Benign diagnosis included pterygium, chalazium, conjunctival nevus, and papilloma, cataract, and retinal detachment. Of the malignant cases, squamous cell carcinoma (SCC) of the conjunctiva was the most frequent with 43 cases (60%). Other diagnoses included choroidal melanoma (8 cases, 11%), retinoblastoma (7 cases, 9%), lymphomas (5 cases, 7%), basal cell carcinomas of the eyelid (4 cases, 5%), conjunctival melanoma (2 cases, 2%), and Kaposi sarcomas (1 case, 1%). Of the 43 patients with SCC, the mean age was 62 years old, and 30 (69%) were male; 29 patients (67%) were treated with an excisional biopsy, and 14 (33%) were treated with neoadjuvant topic chemotherapy, followed by surgery.

Leczenie chirurgiczne znamion spojówki u dzieci

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Rakusiewicz K, Kanigowska K, Grajkowska W, Hautz W. Surgical treatment of conjunctival nevi in pediatric patients. Klinika Oczna / Acta Ophthalmologica Polonica. 2019;121(1):29-33. doi:10.5114/ko.2019.85213. APA Rakusiewicz, K., Kanigowska, K., Grajkowska, W., & Hautz, W. (2019). Surgical treatment of conjunctival nevi in pediatric patients. Klinika Oczna / Acta Ophthalmologica Polonica, 121(1), 29-33. https://doi.org/10.5114/ko.2019.85213 Chicago Rakusiewicz, Klaudia, Krystyna Kanigowska, Wieslawa Grajkowska, and Wojciech Hautz. 2019. "Surgical treatment of conjunctival nevi in pediatric patients". Klinika Oczna / Acta Ophthalmologica Polonica 121 (1): 29-33. doi:10.5114/ko.2019.85213. Harvard Rakusiewicz, K., Kanigowska, K., Grajkowska, W., and Hautz, W. (2019). Surgical treatment of conjunctival nevi in pediatric patients. Klinika Oczna / Acta Ophthalmologica Polonica, 121(1), pp.29-33. https://doi.org/10.5114/ko.2019.85213 MLA Rakusiewicz, Klaudia et al. "Surgical treatment of conjunctival nevi in pediatric patients." Klinika Oczna / Acta Ophthalmologica Polonica, vol. 121, no. 1, 2019, pp. 29-33. doi:10.5114/ko.2019.85213. Vancouver Rakusiewicz K, Kanigowska K, Grajkowska W, Hautz W. Surgical treatment of conjunctival nevi in pediatric patients. Klinika Oczna / Acta Ophthalmologica Polonica. 2019;121(1):29-33. doi:10.5114/ko.2019.85213.

Expression of metastasis associated genes nm23, p53 and S100A4 in conjunctival melanoma and their relationship with invasion and metastasis

Objective To study the significance of metastasis associated genes nm23, p53 and S100A4 in the development of conjunctival melanoma metastasis. Methods Conjunctival melanoma tissue specimens were collected from 42 cases of conjunctival melanoma patients in Henan Eye Hospital from July 2015 to November 2016, meanwhile 30 cases of conjunctival nevus tissue samples served as control group under the informed consent.The expressions of nm23, p53 and S100A4 were detected in conjunctival melanoma group and control group by Western blot and immunohistochemical method.The relationship between the clinical and pathological features of nm23, p53 and S100A4 with conjunctival melanoma patients with lymph nodes metastasis were analyzed. Results Western blot assay showed that the expression level of nm23 in conjunctival melanoma group was lower than that in the control group , with a significant difference between them (P 0.05). There were siginificant differences in nm23, p53 and S100A4 protein expression positive rate between various sclera invasion groups and various distant metastasis groups (all at P<0.05). Conclusions Expression of nm23, p53 and S100A4 may play an important role in the invasion and metastasis of conjunctival melanoma, which may be the main reference index for the diagnosis and treatment. Key words: Conjunctival melanoma; nm23; p53; S100A4; Invasion; Metastasis

Subepithelial conjunctival nevus with atypia: Expanding our understanding of a challenging diagnosis

Equivocal cases of conjunctival subepithelial melanocytic nevus with atypia may on occasion be difficult to distinguish histopathologically and immunohistochemically from melanoma. We describe the clinical presentation and histopathological features of an atypical amelanotic conjunctival nevus, along with its differential diagnosis and pertinent literature review.A 55-year-old Caucasian male presented with an amelanotic epibulbar conjunctival lesion extending onto the cornea, mimicking a pterygium. The histopathological examination of the excision revealed a well-circumscribed subepithelial amelanotic spindle cell melanocytic proliferation with fascicular growth, focal nuclear and cellular enlargement, reverse maturation, less than 1% of cells in cycle, and no mitotic figures. The spindle cells were diffusely immunoreactive to Mart-1, S100, SOX-10, and superficially to MITF and HMB-45. Given the histopathological atypia and ambiguity of stains, the 5-probe fluorescence in situ hybridization NeoSITE (NeoGenomics, Irvine, CA) was performed and found to be normal.The presence of atypia, a sign of pre-malignancy, in amelanotic subepithelial nevi should be suspected, even in cases of presumed pterygia, to ensure that appropriate histopathological evaluation and subsequent management are pursued. Immunohistochemical stains and molecular studies can be crucial in differentiating benign from potentially malignant conjunctival nevi with atypia.

BRAF, NRAS, and GNAQ Mutations in Conjunctival Melanocytic Nevi.

PurposeTo evaluate BRAF, NRAS, and GNAQ mutations in surgical specimens of common and blue conjunctival melanocytic nevi.MethodsSurgical specimens from 25 conjunctival melanocytic nevi (23 common and 2 blue) of 25 patients were evaluated. All common nevi were analyzed immunohistochemically for the expression of BRAF V600E or NRAS Q61R. One lesion with negative immunoreactivity and for all blue nevi, a hybridization capture-based next-generation sequencing method was employed for mutation analysis. For common nevi, genetic features were compared with clinical and histopathologic findings. Continuous variables (age at excision and largest basal diameter) were compared with a Students's t-test and all categoric variables were compared with Fisher's Exact Test.ResultsOf common melanocytic nevi, 9 (39.1%) were immunoreactive for NRASQ61R and 13 (56.5%) were immunoreactive for BRAFV600E. One common nevus, which was immunonegative for both BRAFV600E and NRASQ61R was found to harbor an NRASQ61K mutation by sequence analysis. Patients with NRAS-mutated nevi were more likely to report occurrence of the lesion prior to 18-years old and more likely to have intrinsic cysts. The mean largest basal diameter was 6.0 and 3.5 mm for NRAS- and BRAF-immunoreactive lesions, respectively (P = 0.003). GNAQ mutations were identified in each of the two blue nevi of this study.ConclusionsThese findings document that common conjunctival melanocytic nevi have mutually exclusive mutations in BRAF and NRAS. The two conjunctival blue nevi harbored GNAQ mutations. This suggests the driver mutations of conjunctival nevi are similar to those of nevi of the skin. At the molecular level, conjunctival nevi appear more like cutaneous nevi than choroidal nevi.

Regressing conjunctival nevus in a child

Purpose:To report a case exhibiting drastic regression of a conjunctival nevus in a child.Case Report:Spontaneous regression of conjunctival nevus is uncommon. We report the case of a nine-year-old Caucasian boy presenting a conjunctival-pigmented lesion situated at the plica semilunaris that underwent a significant reduction in size and color over a period of 15 months.Conclusion:Conjunctival nevus in children is common but regression is rare, especially at the plica. This information could form an important part of the consent process when choosing between observation and surgical excision in the management of a small conjunctival lesion with no suspicious clinical features; since the latter invasive treatment involves risks such as infection, scarring and the possible risk of general anesthesia in children.

Fugo Plasma Blade Assisted Ablation of Conjunctival Nevi- A Series of 2 Cases

Fugo Plasma Blade Assisted Ablation of Conjunctival Nevi- A Series of 2 Cases

β‐catenin activation in conjunctival melanocytic proliferations

PurposeConjunctival and cutaneaous melanoma partially share similar genetic alterations. β‐catenin is a dual‐function protein that acts not only as a structural component of adherens junctions but also as an effector molecule involved in the Wnt pathway. In skin melanoma, in vitro activation of the Wnt pathway led to nuclear localization of β‐catenin and increased invasiveness. We investigated the expression and activation of β‐catenin in benign and malignant conjunctival melanocytic proliferations.Methodsβ‐catenin expression was assessed by immunohistochemistry in 43 conjunctival naevi, 48 PAM (including 23 PAM with atypia) and 44 conjunctival melanomas as well as in 4 conjunctival melanoma cell lines at various stages of confluence. Statistical analysis was performed with JUMP 8.0 software.ResultsIn the naevi, membranous expression of β‐Catenin was found in all the cases and nuclear expression in 14% of the cases. In the PAM, membranous expression of β‐catenin was identified in all the cases without nuclear expression. Membranous expression of β‐catenin in melanoma was found in 94% of the cases and nuclear expression in 15.9% of the cases. There were no significant differences in the nuclear expression of β‐catenin between conjunctival nevi and melanoma. In the melanoma group, there was a significant correlation between nuclear expression of β‐catenin and depth of invasion. In the 4 conjunctival melanoma cells lines, no significant nuclear expression of β‐catenin was identified at various stages of confluence.Conclusionsβ‐catenin activation and nuclear localization does not appear to be a major mechanism occurring in conjunctival melanoma. It is however possible that β‐catenin activation might occur at a late stage in tumor development.

Pediatric conjunctival melanoma arising from a compound nevus

We present a rare case of conjunctival melanoma in a 9-year-old girl who presented with a conjunctival lesion of the left eye, growth of which was documented by patient photographs. Examination showed a raised pigmented lesion at the temporal limbus, withfine surrounding vessels. Enhanced depth imaging-optical coherence tomography showed no invasion into the sclera. The patient underwent excisional biopsy, and histopathology revealed conjunctival melanoma arising from a nevus with malignant cells that stained positively with markers HMB-45 and Ki-67. Systemic workup was negative for metastatic disease. Conjunctival nevi are the most common melanocytic conjunctival lesions in children and generally demonstrate physiologic growth during adolescence. Thus, there may be a greater risk of misdiagnosis of conjunctival melanoma in a child.

Analysis of clinicopathologic characteristics of 422 conjunctival melanocytic nevi specimens

Objective: To describe the clinicopathologic characteristics of 422 conjunctival melanocytic nevi and detect the incidence of malignancy in those patients. Methods: Retrospective case series study. A retrospective study was conducted by reviewing 422 conjunctival melanocytic nevi specimens obtained at Beijing Tongren Eye Center from June, 2004 to May, 2016. The data included the information of gender, age, clinical and histopathological diagnosis of all collected conjunctival melanocytic nevi cases. All patients were divided into three groups according to age: juvenile groups (<18 years old), young group (18-40 years old) and the elderly group (>40 years old). The histopathology change and its malignant incidence of conjunctival nevi in different age and sex were analyzed by SPSS 18.0 software package. Results: Of the 422 cases, 195 were males and 227 were females (male∶female=0.89∶1). The average age at surgery was (27.9±17.9) years old. The pathological types of conjunctival nevi included compound nevus, intraepithelial nevus and junctional nevus. The most common type of conjunctival nevus was compound nevus (256 cases, 60.7%; mean age (22.2±15.4) years old). The second was intraepithelial nevus (130 cases, 30.8%; mean age (37.7±16.6) years old). The least was junctional nevus (36 cases, 8.5%, mean age was (32.7±22.4) years old).The average age of patients with different types of conjunctival nevi was statistically significant (F=3.169, P=0.031). Occurrence of conjunctival compound nevus was most common in juvenile group (44.1%), followed by the young group (40.6%), and the elderly group (only 15.2%). Occurrence of conjunctival intraepithelial nevus was the most common in youth group (45.4%), followed by the elderly group (44.6%), and youth group was relatively rare (only 10%). The junctional nevus appeared mainly in elderly group (44.4%), but the junior group also had 13 cases (36.1%) and younger group had 7 cases (19.4%). Among 422 cases of conjunctival nevi, 37 cases transformed into malignant tumor. The canceration rate was 8.8%. The average age of malignant patients was (48.6±12.1) years old. Comparing with the patients without malignant, the age was age (25.3±4.2) years old and there was a significant difference (t=4.252, P=0.002). Among them, 24 cases (64.9%) came from conjunctival compound nevus and 13 cases (35.1%) came from the junctional nevus. Non malignant cases occurred in patients with conjunctival intradermal nevus. The male and female average age of patients with malignant transformation from compound nevus and junctional nevus were not statistically significant (P=0.730, 0.993). Thirteen cases were occurred malignant change in 36 cases of patients with junctional nevus, accounting for 36.1% of all patients with junctional nevus. It was obviously higher than the average malignant incidence of conjunctival nevi (8.8%). Non malignant junctional nevus were most common in juvenile group, and malignant junctional nevus were most common in the elderly group. Conclusions: The pathological type distribution of conjunctival melanocytic nevi in different age groups was different, and the onset age of different types of melanocytic nevi was also different. Patients with junctional nevus were prone to malignant change, and most of them were middle-aged and elderly patients. (Chin J Ophthalmol, 2017, 53: 583-587).

Allogeneic cultured limbal epithelial transplantation: a clinical observation of its treatment effects on large conjunctival lesions

Objective: To introduce the surgical methods and investigate the treatment effects of conjunctival lesion resection combined with transplantation of allogeneic limbal epithelia cultured in vitro for treatment of varied large conjunctival lesions. Methods: A retrospective analysis of case data of the patients receiving transplantation of allogeneic limbal epithelia cultured in vitro for large conjunctival lesions at Qingdao Eye Hospital from January 2013 to December 2015 was conducted. Fresh donor corneal limbal epithelial tissues were obtained for cellular digestion and isolation. The cells were cultured on de-epithelized amniotic membrane to form a stratified cell sheet with 3 to 5 layers of cells for reservation. Conjunctival lesions were removed, and corneal limbal epithelial cell sheets corresponding to the size of the conjunctival defects were covered on the scleral flaps, before the conjunctivae were para sutured with corneal limbal epithelial cell sheets. The stitches were removed 7 days after surgery. The treatment effects were evaluated. Results: There were 11 cases (12 eyes) in this study, including 6 cases (6 eyes) of recurrent pterygium combined with symblepharon, 3 cases (3 eyes) of conjunctival compound nevus, 1 case (1 eye) of conjunctival primary acquired melanosis, and 1 case (2 eyes) of dermoid lipoma. The patients were 6 to 69 years old, with an average age of (46±23) years old. There were 5 male patients and 6 female patients. The follow-up time was 6 to 39 months, with an average time of (24.8±12.4) months. The conjunctival lesions in all patients were more than 2 quadrants. No patients had intraoperative and postoperative complications. No obvious irritation symptoms were observed after surgery. There were a few small pieces of epithelial defects on the limbal epithelial cell sheets at the end of the operation due to operative injury. With postoperative cellular proliferation and repair, the epithelium gradually healed and tended to become firm, and the boundaries with original conjunctival epithelium gradually disappeared. The healing time of the epithelium after surgery was 3 to 7 days, with an average time of (4.5±1.2) days. No immunological rejection occurred after surgery. No recurrence of original diseases was observed among all the patients at the last follow-up. Conclusions: Transplantation of allogeneic cultured limbal epithelial cells, which was carried out for the treatment of large conjunctival lesions, witnessed rapid epithelization at the areas of lesion resection. It could reduce the risk of recurrence of original diseases and effectively avoid the occurrence of postoperative symblepharon. The postoperative inflammatory reaction was also minor. (Chin J Ophthalmol, 2017, 53:172-176).

Immunohistochemical profiling including beta-catenin in conjunctival melanocytic lesions

Conjunctival melanocytic lesions encompass a group of clinically diverse, benign to malignant, neoplasms that may contain overlapping histopathological features, making definitive diagnosis challenging in some cases. In this series, we compared multiple immunohistochemical (IHC) markers in 11 conjunctival nevi, 10 primary acquired melanosis (PAM) lesions, and 11 conjunctival melanomas. Immunostains included the melanocytic markers HMB-45 and Melan-A, as well as the proliferative marker Ki-67. Loss of beta-catenin expression has been associated with more aggressive clinical disease in cutaneous melanoma, but its status in conjunctival melanocytic lesions is not known, therefore we incorporated beta-catenin immunohistochemical staining in our study. In this series, conjunctival melanomas had a higher Ki-67 proliferative index and HMB-45 immunoreactivity than did PAM lesions and conjunctival nevi (P<0.001). Melan-A was highly expressed in all 3 groups. Beta-catenin was more strongly expressed in melanomas and nevi than in PAM (P<0.001). There was high inter-grader reliability (Kappa=0.53). Overall, IHC labeling of HMB-45 and Ki-67 is increased in conjunctival melanomas compared to PAM or conjunctival nevi. Beta-catenin, an IHC marker previously unstudied in conjunctival melanocytic lesions, is not preferentially expressed in benign lesions and may play a different role in conjunctival atypia than it does in cutaneous melanoma.

Surgical amniotic membrane transplantation after conjunctival and limbal tumor excision.

To evaluate the clinical results of patients treated by amniotic membrane transplantation (AMT) following excision of conjunctival and limbal tumors. A total of 14 eyes of 14 patients who underwent AMT after total lesion-free tumor excision and perilesional cryotherapy were evaluated. The excised tumors comprised 7 conjunctival intraepithelial neoplasia, 5 conjunctival nevus, 1 primary acquired melanosis, and 1 squamous cell carcinoma. Limbus was involved in 10 cases, whereas cornea was involved in 6 cases. The average measurement of the tumor base was 14.8 mm (range 6-20 mm, SD 16 mm). The mean follow-up time period was 17.5 months (range 6 -60 months, SD 20 months). Complete healing occurred in eight eyes, but limbal cell deficiency developed in two eyes. Four cases had recurrence and were treated with the same surgical and medical procedures; during follow-up after recurrence, superficial peripheral vascularization and corneal scar were noted to have developed. AMT was effective for reconstruction of tissue defect after excision and cryotherapy of limbal and conjunctival tumors. In most of these cases, complete healing was achieved with a smooth, stable, and translucent surface.

Management of conjunctival lesions

Objective The aim of this study was to detect, diagnose, and treat the different conjunctival lesions over a period of 1 year. Background The conjunctiva is the site of expression of many lesions either benign or malignant and are worthy of study. Patients and methods The study was conducted on patients attending the Outpatient Clinic of Ophthalmology in Menoufia University Hospital. It was conducted on 159 patients with conjunctival lesions. Cases were examined and managed and the data were analyzed. Results The study included 159 cases. Overall, 100 cases (62.9%) were male and 59 cases (37.1%) were female. As regards age, 129 cases (81%) were adult (mean age: 56 ± 19.5) and 30 cases (19%) were children (mean age 11 ± 6.5). Benign conjunctival lesions were the most common and represented 155 cases (97.5%). The most common lesions were benign pigmented conjunctival lesions (41 cases, 25.8%). The second most frequent lesions were pterygia (40 cases, 25.2%). Pingueculae were the third most common conjunctival lesions (30 cases, 18.9%). The remaining lesions included allergic conjunctival masses (16 cases, 10%), epibulbar choriostomas (12 cases, 7.6%), pyogenic granuloma (eight cases, 5%), orbital fat herniation (four cases, 2.5%), cystic lesions (four cases, 2.5%), and ocular surface squamous neoplasia (four cases, 2.5%). Conjunctival lesions among children (in the decreasing order of frequency) included conjunctival choriostomas (12 cases, 30%), conjunctival nevi (11 cases, 27.5%), allergic conjunctival lesions (eight cases, 20%), congenital melanosis (six cases, 15%), conjunctival Tenon's cyst (two cases, 5%), and one case of pyogenic granuloma (2.5%). Conclusion Benign conjunctival lesions are the most frequent, although some tumors may hide systemic association or malignant tumor. Hence, any suspicious conjunctival lesion should be excised carefully and sent for histopathological analysis and close follow-up is recommended.

Melanocytic Nevus of the Tarsal Conjunctiva.

Melanocytic nevus is a rare occurrence in the tarsal conjunctiva and only 7 well-described cases have been reported previously in the English literature. The medical records of 4 patients with tarsal conjunctival melanocytic nevus were reviewed, together with the relevant literature. All patients (3 women and 1 man; age range: 17 - 40 years) had been referred with a suspicion of melanoma. There was one tarsal nevus in the lower eyelid in 3 patients and 2 nevi in the upper eyelid in 1 patient. All lesions were darkly pigmented with irregular borders and were associated with a history of a recent growth in size. An intralesional cyst was present in 1 nevus only. After surgical excision, no recurrence or complication occurred during the follow-up period (range: 7 - 48 months). Tarsal melanocytic nevus has been described in detail in 11 cases, including these 4 cases, in the English literature. The lesion arose from the lower eyelid in all cases except one. Tarsal melanocytic nevi may frequently display clinical features suggesting melanoma, such as advanced patient age, recent growth, dark and irregular pigmentation, nodularity, hypervascularity, and the absence of an intralesional cyst. After total excision, nevus recurrence or malignant transformation has not been reported.

Targeting of the MAPK and AKT pathways in conjunctival melanoma shows potential synergy.

PurposeConjunctival melanoma (CM) is a rare but lethal form of cancer. Similar to cutaneous melanoma, CM frequently carries activating mutations in BRAF and NRAS. We studied whether CM as well as conjunctival benign and premalignant melanocytic lesions express targets in the mitogen-activated protein kinase (MAPK) and AKT pathways, and whether specific inhibitors can suppress CM growth in vitro.Methods131 conjunctival lesions obtained from 129 patients were collected. The presence of BRAF V600E mutation and expression of phosphorylated (p)-ERK and p-AKT were assessed by immunohistochemistry. We studied cell proliferation, phosphorylation, cell cycling and apoptosis in three CM cell lines using two BRAF inhibitors (Vemurafenib and Dabrafenib), a MEK inhibitor (MEK162) and an AKT inhibitor (MK2206).ResultsThe BRAF V600E mutation was present in 19% of nevi and 26% of melanomas, but not in primary acquired melanosis (PAM). Nuclear and cytoplasmic p-ERK and p-AKT were expressed in all conjunctival lesions. Both BRAF inhibitors suppressed growth of both BRAF mutant CM cell lines, but only one induced cell death. MEK162 and MK2206 inhibited proliferation of CM cells in a dose-dependent manner, and the combination of these two drugs led to synergistic growth inhibition and cell death in all CM cell lines.ConclusionERK and AKT are constitutively activated in conjunctival nevi, PAM and melanoma. While BRAF inhibitors prohibited cell growth, they were not always cytotoxic. Combining MEK and AKT inhibitors led to more growth inhibition and cell death in CM cells. The combination may benefit patients suffering from metastatic conjunctival melanoma.

Melanoma da conjuntiva localizado em pálpebra superior

Melanoma of the conjunctiva (MC) is a tumor that can affect the next bulbar conjunctiva to the limbus, conjunctiva, eyelid, forniceal in plica or caruncles region, which may originate from melanosis areas acquired primary with atypia, conjunctival nevus areas, and no local lesions. Clinically it presents itself as a mass or a high pigmented conjunctival lesion. This Study aimed at describing a case of conjunctival melanoma multifocal from preexisting pigmented nevus. Histopathological diagnosis and staging of early conjunctival lesion is extremely important to designate the management of patients.