Pigmented Conjunctival Lesions as Presenting Signs of Vaginal Melanoma

A 43-year-old woman was referred to an oculoplastic surgeon for the evaluation of 2 small pigmented lesions in the tarsal conjunctiva. She underwent a biopsy of the lesions, both of which were found to be consistent with metastatic melanoma. Follow-up with the patient revealed that she had been hospitalized for balance issues and headaches. An MRI of her brain revealed a hemorrhagic mass and several smaller foci suspicious for metastatic lesions. A thorough workup included an evaluation for bloody vaginal discharge. Biopsy of a pigmented portion of the vaginal mucosa lesion revealed BRAF-positive melanoma. This was determined to be the primary site of her malignant metastatic melanoma, which caused her death within 6 months of presentation.