Conjunctival Melanoma With Morphologic Diversity and Orbital Invasion

Area of Science:

• Ophthalmology
• Dermatopathology
• Oncology

Background:

• Conjunctival melanoma is a rare malignancy of the eye.
• Previous history of dysplastic nevi can be a risk factor.
• Eyelid nodules require thorough investigation.

Observation:

• A 68-year-old male presented with a year-long history of a progressive, firm lower left eyelid nodule.
• Examination revealed an inferior anterior orbital nodule and mild conjunctival pigmentation.
• Magnetic resonance imaging showed orbital infiltration by the mass.

Findings:

• Biopsy confirmed conjunctival melanoma.
• Histopathology revealed a unique conjunctival melanoma with morphological diversity.
• Concurrent presence of staghorn patterns, signet-ring cells, and rosettoid patterns was noted.
• This represents the first documented case of multiple morphologic patterns within a single conjunctival melanoma.

Implications:

• Early diagnosis and aggressive treatment, such as exenteration, are crucial for managing invasive conjunctival melanoma.
• The presence of diverse morphologic patterns may influence prognosis and treatment strategies.
• This case highlights the importance of recognizing rare presentations of conjunctival melanoma.