Borderline melanocytic tumor of the conjunctiva: diagnostic and therapeutic considerations

A clinically benign appearing nevus was surgically excised from the conjunctiva of a 13-year-old girl because of complaints that it had recently enlarged. Histologically, the melanocytic lesion displayed considerable cytologic atypia and showed signs that were consistent with malignant transformation. Because of the rarity of conjunctival melanomas in children, the case was reviewed by several experienced pathologists and dermatopathologists whose diagnoses ranged from benign nevus with atypia to malignant melanoma. When the biologic potential of certain melanocytic lesions cannot be accurately predicted histologically, treatment and follow up must be individualized. Physicians must weigh the perceived risks and disadvantages of treating a histologically indeterminate tumor against the consequences of "under" treatment if the lesion is, in fact, biologically malignant.