Conjunctival Nevi Research Articles

Expression of endoglin, CD105, in conjunctival melanocytic nevi: Is it suspicious like in thyroidology? Oculi plus vident quam oculus?

The aim of this study was to evaluate the expression of endoglin and its correlation with histopathological and clinical findings in conjunctival nevi. The study included archival formalin-fixed, paraffin-embedded tissue sections of 44 patients with conjunctival nevi. Immunohistochemical staining for CD105 had been performed with monoclonal mouse antihuman CD105 antibodies. The intratumoral microvessel density for quantification of tumoral vascularization had been determined by this marker. The expression of CD105 was positive in 30 (68.2%) cases. There was a statistically significant difference in the level of CD105 expression regarding the histological type of nevus (p=0.03) and intralesional cysts status (p=0.02). Spearman's rho (ρ -0.316) revealed a significant negative correlation between the expression of endoglin and the histological type of nevus (p=0.03) and between the expression of endoglin and the presence of intralesional cysts (ρ -0.380, p=0.01). This study suggests that endoglin could be a useful diagnostic and prognostic marker in differentiating between benign and malignant melanocytic ocular lesions.

Clinical profile of melanocytic lesions of the ocular surface in a Hispanic population.

To determine the prevalence, clinical characteristics, and demographic factors of melanocytic lesions of the ocular surface, such as racial melanosis, primarily acquired melanosis, conjunctival nevus, and conjunctival melanoma in a Hispanic population. A cross-sectional and observational study was undertaken in a tertiary referral ophthalmological center in northern Mexico from December 2020 to April 2021. All patients attending an ophthalmology specialty clinic were screened during their first visit in order to detect melanocytic lesions of the ocular surface. Demographic factors, clinical characteristics, and diagnosis and treatment were recorded. 227 patients were screened for melanocytic lesions. Melanocytic lesions were identified in 114 patients (50.2%). The prevalence of the different melanocytic lesions in the screened population was racial melanosis, 45.3%; primary acquired melanosis, 3.5%, and conjunctival nevus 1.3%. No conjunctival melanoma was identified in the screened population. Primary acquired melanosis was more common in the fifth to sixth decade of life and in females. Racial melanosis showed no gender predilection and was also more common in the fifth to sixth decade of life. Only 1 melanocytic lesion (a primary acquired melanosis) required medical treatment with excisional biopsy and cryotherapy. The prevalence of racial melanosis is remarkably high in the Hispanic population. While less prevalent, primary acquired melanosis is also present in a considerable percentage of Hispanic patients. Both melanocytic lesions exhibit demographic characteristics that match those previously reported in the medical literature.

Conjunctival Balloon Cell Nevus in a Young Child: A Case Report

Background: Conjunctival balloon cell nevus is rare and often presents in young adults to middle-aged patients with a longstanding history of melanocytic lesion, suggestive of benign pathology. The main treatment modality is excisional biopsy. Tumor recurrence is very rare. Malignant transformation has never been reported. Objective: This study aimed to report a case of conjunctival balloon cell nevus with an atypical presentation in a preschooler. Methods: We describe a case of a 5-year-and-9-month-old girl who presented with a rapidly growing melanocytic conjunctival mass, which she had since birth. Ophthalmic examination showed two prominent feeder vessels, and the lesion straddled the limbus to overlie the peripheral part of the cornea. These findings raised an index of suspicion of malignant transformation. The lesion was completely excised with a 2-mm resection margin, superficial keratectomy, ethyl alcohol epitheliectomy, and cryotherapy. Results and Discussion: The histopathological examination and immunohistochemical study showed a compound conjunctival nevus of the conjunctiva with most of the cells as balloon cell type. There were no malignant changes found. Moreover, there were no signs of tumor recurrence at the last follow-up of 6 months. Conclusion: Clinically malignant characteristics have never been reported in balloon cell nevi in a preschooler of this age. Thorough physical examination, well-planned surgical procedure, and careful pathological examination all play vital roles in the management of patients with these lesions.

Oncocytoma of the Eyelid

Purpose: To report a case of oncocytoma of the eyelid.Case summary: A 70-year-old male visited the ophthalmic clinic, complaining of a mass on his right lower eyelid that had grown steadily in size over the period of 1 year. At the time of his visit, his best-corrected visual acuity was 0.8 in the right eye and 0.8 in the left eye. The eyelid mass had a shape similar to that of a conjunctival nevus, and there was neither pain nor discharge. The eyelid mass was excised under local anesthesia. The mass biopsy presented as oval polygonal cells rich in eosinophilic granules in the cytoplasm. Based on this finding, the patient was diagnosed with oncocytoma of the eyelid. The patient has been under follow-up without further treatment or recurrence. Conclusions: Oncocytoma of the eyelids is rare and has not been reported in Koreans; however, very rare but aggressive forms have been reported. Thus, it is necessary to make an accurate diagnosis through biopsy and close follow-up.

Epidemiological and histopathological features of ocular tumors in Bukavu, Democratic Republic of the Congo

Purpose: To describe epidemiological and histopathological features of ocular tumors observed in two ophthalmology departments in Bukavu in the Democratic Republic of the Congo. Methods: A cross-sectional descriptive study and a simple proportion analysis were performed to describe the epidemiological and histopathological characteristics of 103 consecutive anatomical pieces taken after tumor removal from two ophthalmology services in Bukavu city from January 2018 to December 2020. Results: Children accounted for 40% of patients and ocular tumors were unilateral in 84.5% of cases. The most common locations were the retina (34.8%), conjunctiva (33.7%) and eyelids (22.8%). Benign tumors predominated (51.4%), followed by malignant tumors (37.9%), and undetermined tumors (15.5%). The main histological forms found were retinoblastoma (34.8%), conjunctival nevus (20.6%), and palpebral granuloma (16.3%). Conclusion: Ocular tumors are common in Bukavu. Histopathological examination remains essential to guide management to reduce the risk of recurrence and related complications.

A Congenital Melanocytic Hairy Nevus of the Face and Conjunctival Nevus

A Congenital Melanocytic Hairy Nevus of the Face and Conjunctival Nevus

Histopathological analysis of juvenile patients with melanocytic lesions of the conjunctiva

Objective: This study aimed to examine the frequency of atypical features in conjunctival nevi in pediatric patients referred to the McGill University Health Center-McGill University Ocular Pathology and Translational Research Laboratory and to emphasize the importance of histopathological analysis to rule out malignant lesions, such as melanoma.Methods: Forty-four pediatric patients younger than 20 years of age previously diagnosed with melanocytic lesions of the conjunctiva were included in this study, and the database was analyzed for a 10-year period (2006–2015). Clinical information such as age, gender, location, type, size, and agreement between clinical and pathological diagnosis was also recorded and presented as means and percentages.Results: The mean age was 11.3 years, of which only 9.1% were older than 18 years. Gender predilection was found toward males (52.3%). An agreement was noted between clinical and pathological diagnosis in 77.2% of cases; only 22.72% showed atypia upon histopathological examination. The most common pathological diagnosis was compound nevus with different characteristics. The atypical lesions included conjunctival melanoma, junctional nevi with atypia, compound nevi with atypia, and cystic compound nevi. Moreover, 70% of the patients with atypical lesions were males and 60% of the specimens were from the right eye.Conclusion: An impressive number of 30% of all patients had some type of atypia after histopathological analysis. Therefore, based on these results, it is of extreme importance that all melanocytic lesions are sent for histopathological analysis, so an accurate diagnosis can be established.

Impression Cytology's Reliability as an Effective Method for Ophthalmic Neoplasm Detection.

Background:The current investigation was intended to evaluate the precision of impression cytology and tissue histology in the detection of ocular surface neoplasia.Materials and Methods:We examined the histories of patients detected with ocular surface neoplasia at the Department of Ophthalmology, Kalinga Institute of Medical Sciences, Bhubaneswar. All the patients had their impressions cytology and tissue samples taken. The outcomes of both strategies were compared.Results:There were a total of 55 patients (33 males and 22 females) aged 12–99 years (average age, 51 years). Twenty patients had injuries to the right eye and 35 had injuries to the left eye. Conjunctival–corneal intraepithelial neoplasia (38.2%), squamous cell carcinoma (34.5%), squamous epithelium (10.9%), squamous papilloma (7.3%), conjunctival nevi (7.3%), Along with the most common histological research, malignant melanoma (1.8%). Compared with the histological results, impression cytology showed positive and negative assessment accuracies of 97.4% and 52.9%, respectively. In squamous neoplasms, squamous cell carcinoma exhibited a strong link with histology. The occurrence of dysplastic cells raised suspicion of malignancy.Conclusion:Because of its increased accuracy in detecting lesions, along with tissue histology, impression cytology exhibits enormous potential in identifying ocular surface neoplasia. However, impression cytology has an undesirable prognostic accuracy, indicating that it is a useful screening tool but cannot be considered as a “gold standard.”

Evaluation of Plasma-Assisted Noninvasive Surgery (PANIS) as a New Technique for Sublimating Large Benign Conjunctival Nevus with Amniotic Membrane Transplantation (AMT); A Clinical Case Report

Evaluation of Plasma-Assisted Noninvasive Surgery (PANIS) as a New Technique for Sublimating Large Benign Conjunctival Nevus with Amniotic Membrane Transplantation (AMT); A Clinical Case Report

A Rare Case of Giant Conjunctival Nevus with Amniotic Membrane Graft Reconstruction in Rural India

Conjunctival nevi are the most common melanocytic tumors of the eye. The benign conjunctival nevus typically harbors conjunctival inclusion cysts that are detectable both clinically and histopathologically, which differentiates it from the other pigmented conjunctival lesions. They commonly affect teenagers and young adults. In our case, we have performed excision of the nevus with amniotic membrane grafting in which we have procured and processed the amniotic membrane ourselves.

5-Hydroxymethylcytosine Loss in Conjunctival Melanoma.

Aims: Conjunctival and cutaneous melanoma partially share similar clinical and molecular backgrounds. As 5-hydroxymethylcytosine (5-hmC) loss has been demonstrated in cutaneous melanoma, we decided to assess if similar changes were occurring in conjunctival melanoma. Methods: 5-methylcytosine (5-mC), 5-hmC and TET2 were respectively identified by immunohistochemistry and RNA ISH in 40 conjunctival nevi and 37 conjunctival melanomas. Clinicopathological correlations were established. Results: 5-mC, TET2 and 5-hmC were respectively identified in 67.5%, 95% and 100% of conjunctival nevi and in 81.1%, 35.1% and 54% of conjunctival melanomas. A significant 5-hmC and TET2 loss was identified in conjunctival melanoma comparing to nevus, as well as a significant correlation between TET2 and 5-hmC expression. In the melanomas, 5-hmC expression was only significantly associated with local lymphatic invasion, but not with other clinicopathological parameters. There was a correlation between TET2 expression and the localization of the tumors. 5-mC expression was not associated with any clinicopathological parameters. Conclusions: We identified a significant 5-hmC loss in conjunctival melanoma similar to cutaneous melanoma. This loss may possibly be attributed to TET2 loss or IDH1 mutations. 5-hmC loss in conjunctival melanoma may help in the differential diagnosis between atypical conjunctival nevus and conjunctival melanoma.

Adopting low-shot deep learning for the detection of conjunctival melanoma using ocular surface images

Background and ObjectiveThe purpose of the present study was to investigate low-shot deep learning models applied to conjunctival melanoma detection using a small dataset with ocular surface images. MethodsA dataset was composed of anonymized images of four classes; conjunctival melanoma (136), nevus or melanosis (93), pterygium (75), and normal conjunctiva (94). Before training involving conventional deep learning models, two generative adversarial networks (GANs) were constructed to augment the training dataset for low-shot learning. The collected data were randomly divided into training (70%), validation (10%), and test (20%) datasets. Moreover, 3D melanoma phantoms were designed to build an external validation set using a smartphone. The GoogleNet, InceptionV3, NASNet, ResNet50, and MobileNetV2 architectures were trained through transfer learning and validated using the test and external validation datasets. ResultsThe deep learning model demonstrated a significant improvement in the classification accuracy of conjunctival lesions using synthetic images generated by the GAN models. MobileNetV2 with GAN-based augmentation displayed the highest accuracy of 87.5% in the four-class classification and 97.2% in the binary classification for the detection of conjunctival melanoma. It showed an accuracy of 94.0% using 3D melanoma phantom images captured using a smartphone camera. ConclusionsThe present study described a low-shot deep learning model that can detect conjunctival melanomas using ocular surface images. To the best of our knowledge, this study is the first to develop a deep learning model to detect conjunctival melanoma using a digital imaging device such as smartphone camera.

Conjunctival Melanoma: Outcomes based on the American Joint Committee on Cancer Clinical Classification (8th Edition) of 425 Patients at a Single Ocular Oncology Center.

The aim of this study was to evaluate outcomes of conjunctiva melanoma based on the American Joint Committee on Cancer Classification (AJCC) 8th edition. Retrospective interventional case series. Outcomes analysis of 425 patients. In this analysis of 425 patients with conjunctival melanoma, there were 266 (63%) patients classified as T1, 75 (18%) as T2, 84 (20%) as T3, and 0 (0%) as T4. A comparison (T1 vs T2 vs T3) revealed that history of primary acquired melanosis was more common in T2 (81% vs 96% vs 81%; P = 0.01) and conjunctival nevus more common in T1 (20% vs 9% vs 11%; P = 0.03). Of 381 patients with follow-up (mean of 57.6 months), comparison revealed higher T category with increasing local recurrence/new tumor (30% vs 43% vs 49%; P = 0.004), increasing exenteration (3% vs 9% vs 28%; P < 0.001), increasing melanoma-related locoregional lymph node metastasis (2% vs 7% vs 12%; P = 0.001), increasing melanoma-related systemic metastasis (9% vs 25% vs 23%; P < 0.001), and increasing melanoma-related death (4% vs 12% vs 18%; P < 0.001). A comparison at 10 years revealed visual acuity loss of >3 lines (32% vs 42% vs 63%; P < 0.001), melanoma recurrence/new tumor (47% vs 70% vs 74%; P < 0.001), exenteration (4% vs 24% vs 46%; P < 0.001), melanoma-related locoregional lymph node metastasis (3% vs 13% vs 25%; P < 0.001), melanoma-related systemic metastasis (13% vs 45% vs 40%; P < 0.001), and melanoma-related death (8% vs 22% vs 37%; P < 0.001). Based on the AJCC 8th edition of conjunctival melanoma, the 10-year risk per T category significantly increased for visual acuity loss of >3 lines, recurrence/new tumor, exenteration, locoregional and systemic melanoma-related metastasis, and melanoma-related death.

Indocyanine Green Angiographic Assessment of Conjunctival Melanocytic Disorders.

To investigate whether transvascular indocyanine green (ICG) dye leakage is associated with conjunctival malignancy. This is a prospective interventional study. Patients presenting with circumscribed conjunctival melanocytic disorders (CMDs) were included and examined using color photography, anterior segment optical coherence tomography to measure lesion size, and fluorescein and ICG angiography to measure vascular pattern and leakage. Time to vascular leakage was measured by 2 independent observers. Lesions were characterized as benign or malignant based on histopathological features. Thirty patients with CMD were included: 22 lesions were benign (conjunctival nevus, n = 20; conjunctival melanocytic intraepithelial neoplasia without atypia, n = 2) and 8 were malignant (in situ conjunctival melanoma n = 2; invasive conjunctival melanoma, n = 6). Malignant lesions had larger mean maximal diameters (11.0 ± 4.5 vs. 4.2 ± 2.5 mm, P = 0.003) and more frequently showed intrinsic tumor vasculature (8 of 8 vs. 10 of 22, P = 0.007). The mean time to ICG leakage was 350.9 ± 165.9 seconds in benign and 59.6 ± 22.1 seconds (P = 0.002) in malignant lesions and was inversely correlated with lesion size and thickness. Time to angiographic ICG dye leakage is significantly shorter in malignant versus benign CMD.

Nevus of Ota with palatal involvement and Helicobacter pylori gastritis

Congenital oculodermal melanocytosis is also known as Nevus of Ota, condition where blue nevus of skin and orbit are seen with ipsilateral nevus in conjunctiva and iris. They are often associated with glaucoma which can occur at any age. They can have melanocytosis and develop choroidal melanoma. We report a case of a middle-aged female with facial pigmentation and bilateral scleral, conjunctival, and iris nevus with an advanced glaucomatous change in both eyes and pigmentation of the palatal mucosa. Trabeculectomy with mitomycin-C application was done in the left eye. Gastrointestinal endoscopy by gastroenterologist showed gastritis and Helicobacter pylori infection.

Successful surgical management of large conjunctival nevus in a 10-year-old child with resection and amniotic membrane transplantation

The purpose of this paper is to illustrate a case of large conjunctival nevus in a 10-year-old boy which was successfully treated with surgical excision and amniotic membrane transplant (AMT) reconstruction. The conjunctival nevus was initially noticed by the parents 1 year prior to presentation; they reported it had increased in size over the past 3 months. Slit-lamp examination revealed a pigmented conjunctival nevus measuring 5.5 mm vertically and 6.5 mm horizontally, with well-demarcated margins and presence of an intralesional cyst at the temporal bulbar conjunctiva, involving the limbus and encroaching onto the cornea. Complete resection of the conjunctival lesion and bulbar conjunctival reconstruction were performed. The histopathological examination showed conjunctival nevus. The wound healed well with vision of 6/6 and no recurrence. Surgical resection combined with AMT is a successful and an effective way to treat conjunctivalnevus.

Hybrid autofluorescence and photoacoustic label-free microscopy for the investigation and identification of malignancies in ocular biopsies

We demonstrate the development and application of a prototype hybrid microscopy system integrating autofluorescence (AF) and photoacoustic (PA) label-free contrast modes, for the differentiation of ocular tumors in human surgical biopsies. Hybrid imaging was performed in conjunctival nevi and uveal melanomas tissue sections to acquire quantified data for each molecular background. The AF and PA signals were spatially correlated to establish a novel malignancy indicator that could detect melanomas with high accuracy (t-test; p<0.01). The proposed methodology has the potential to simplify relevant diagnostic procedures and paves the way for the development of novel ophthalmoscopes aiming to the early diagnosis of ocular malignancies in a clinical setting.

Conjunctival nevi and melanoma: multiparametric immunohistochemical analysis, including p16, SOX10, HMB45, and Ki-67

The role of p16 in the diagnosis and prognosis of conjunctival melanocytic lesions in the context of other clinical and immunohistochemical parameters has not been systematically explored. This study was conducted to determine whether p16 is a useful parameter in the diagnosis and prognosis of conjunctival melanocytic nevi and melanoma, either independently or as a component of immunohistochemical panels. Sixty-one patients underwent 61 biopsies for conjunctival melanocytic lesions between 2014 and 2018. Pathologic diagnoses were melanoma (n=25, 41%), nevus (n=21, 34%), and conjunctival melanocytic lesion of uncertain malignant potential (n=15, 25%). The biopsies were assessed for expression of p16, SOX10, HMB45, and Ki-67. In a multivariable model, the parameters most predictive of melanoma versus nevus were diffuse HMB45 staining (odds ratio [OR]=45, confidence interval [CI]=4.4-457, P=.02] and p16 nuclear H-score≤115 (OR=9.5, CI=1.2-77; P=.04). There was no association of p16 expression with melanoma thickness. Next-generation sequencing identified no CDKN2A mutations or copy number alterations in 12 conjunctival melanomas, including the tumors with absent p16 expression. This study demonstrates that p16 immunohistochemical stain is useful in distinguishing conjunctival melanocytic nevi from melanoma, particularly in combination with HMB45. P16 expression does not appear to correlate with CDKN2A status and melanoma thickness.

Differential diagnosis and management of melanocytic lesions of the ocular surface

Our purpose is to summarize the actual knowledge about melanocytic lesions of the ocular surface (conjunctival nevus, primary acquired melanosis and conjunctival melanoma),especially their clinical appearance, differential diagnosis and treatment. Conjunctival nevus is the most common benign, conjunctival melanocytic lesion. Primary acquired melanosis mainly presents in middle-aged or elderly individuals, characterized by proliferation of melanocytes of the conjunctival epithelial layer. Conjunctival melanoma is a rare tumor, it is the second most common malignant ocular surface tumor after ocular surface squamous neoplasia and the third most common ocular malignancy following choroideal malignant melanoma and ocular surface squamous neoplasia. Early recognition and proper management of conjunctival melanoma is indispensable due to its high malignant and metastatic potential. Due to frequent recurrences, the knowledge and use of intra- and postoperative adjuvant treatment modalities, and regular follow-up are necessary. Orv Hetil. 2020; 161(15): 563–574.

Ocular and Periocular Tumors in Asian Indian Children and Adolescents

To describe eye tumors in Indian children (age £ 21 years) presenting to a multi-tier ophthalmology hospital network in India. Hospital-record review. During the 3-year study period (November, 2015-October, 2018), 2911 children were diagnosed with 3003 eye tumors. The three most common benign tumors included conjunctival nevus (445, 22%), orbital dermoid cyst (206, 10%), and periocular infantile capillary hemangioma (181, 9%). The three most common malignant tumors included retinoblastoma (835, 88%), xeroderma pigmentosa related ocular surface squamous neoplasia (38, 4%), and rhabdomyosarcoma (17, 2%). Based on the age group, retinoblastoma (n=834, 28%) was the most common tumor in all groups, except adolescence where conjunctival nevus (n=194, 21%) was the most common. Overall, retinoblastoma is the most common tumor in children encountered in a referral based comprehensive ocular oncology practice in India.