Journal
OCULAR SURFACE
Volume 10, Issue 4, Pages 251-263Publisher
ELSEVIER SCIENCE BV
DOI: 10.1016/j.jtos.2012.08.002
Keywords
BRAF; complexion-associated melanosis; conjunctival melanosis; genetics; melanoma; nevus; no-touch surgery; ocular surface; pigmented lesion; primary acquired melanosis (PAM); topical chemotherapy
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Funding
- NIH Center Core Grant [P30EY014801]
- Research to Prevent Blindness Unrestricted Grant
- Department of Defense (DOD) [W81XWH-09-1-0675]
- Ronald and Alicia Lepke Grant
- Jimmy and Gay Bryan Grant
- Hager Family Grant
- Max-Kade-Foundation, NY
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Pigmented conjunctival lesions primarily include melanoma, nevus, primary acquired melanosis (PAM), and complexion-associated melanosis. The incidence of conjunctival malignant melanoma (CMM) has significantly increased in the USA and Europe over the years, and it carries a very serious risk for metastasis and melanoma-related death. Conjunctival melanoma can arise de novo or from precursor lesions, nevus, and PAM. PAM is histologically separated into two distinct forms: PAM with atypia and without atypia. PAM with severe atypia progresses to malignant melanoma in up to 50% of cases and PAM without atypia virtually never progresses. Nevus is a benign melanocytic tumor that only rarely undergoes malignant transformation. Complexion-associated melanosis is frequently seen in more darkly pigmented individuals and does not progress to melanoma, although it can become very large. A detailed literature review on the various pigmented conjunctival lesions together with a schematic approach to diagnosis and management is presented.
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