Conjunctival Melanosis: Review of the Literature

Background: Conjunctival melanoses are a common clinical finding of flat granular melanotic pigmentation of the conjunctival epithelium. Differential diagnosis of these lesions is difficult and there is much confusion in the literature regarding their classification. Objective: To update the readers' knowledge about conjunctival melanosis and its clinicopathologic classification. Method: The author searched electronic databases for primary studies (MEDLINE, EMBASE, and CINAHL) and systematic reviews (PubMed) from the early 1960 when these lesions were described until the end of December 2012. Selection Criteria: English-language systematic reviews; randomized, controlled trials; and quasi-randomized, controlled trials for conjunctival melanosis. Data collection and analysis: Abstracts were screened and data were extracted and reviewed by the author. Result: The conjunctival melanoses are a group of diseases characterized by flat granular melanin-pigmentation of conjunctival epithelium. Because differential diagnosis of these lesions is difficult, there is much confusion in the literature regarding their classification. Conclusion: Benign, melanosis should be divided based on clinical findings into complexion-associated melanosis, secondary melanosis, ephelis, and primary acquired melanosis without atypia. Primary acquired melanosis with atypia is more likely to evolve into a malignant melanoma.