Conjunctival melanocytic tumors in children - a challenge in diagnosis and treatment

Conjunctival melanocytic lesions are very diverse pigmented tumors that include benign, premalignant and malignant tumors. The aim of this article is to highlight the clinical and histopathological aspects of conjunctival melanocytic tumors at children. This study is a retrospective case series study of three patients selected from fifteen cases with melanocytic conjunctival tumors who were operated in the Department of Ophthalmology, "St. Spiridon" Emergency Hospital, Iasi, Romania. A systematic review of the literature was undertaken, using an electronic search of PubMed/MEDLINE, Google Scholar and ISI Web of Knowledge, to identify original English or French articles and reviews on this subject. Patients were diagnosed by the same doctor between 2004 and 2016, in ambulatory of Department of Ophthalmology of the same Hospital. The age of patients was between 7 and 17 years old. Three cases (boys) were treated by surgery - one patient with conjunctival malignant melanoma (histologically confirmed) derived from a pre-existing benign conjunctival nevus (diagnosed 1.5 years before), a patient was operated for aesthetic reasons (with histological diagnosis of compound conjunctival melanocytic nevus) and one boy was diagnosed of melanocytic conjunctival nevus. All cases operated had normal visual acuity and fundoscopy. There was no regional lymph node present in any case studied. The traditional method for clinical diagnosis of suspected pigmented conjunctival lesions was to remove these lesions surgically and to examine architectural and cytological features with light microscopy. We recommend an immunohistochemical staining for the detection of specific cellular antigens in conjunctival melanocytic tumors in children. The diagnosis, treatment and the follow-up of the patient were challenges for the ophthalmologist.