Pigmented Inflamed Seborrheic Keratosis of the Bulbar Conjunctiva

Area of Science:

• Ophthalmology
• Dermatology
• Pathology

Background:

• Pigmented epibulbar lesions can be mistaken for ocular surface squamous neoplasia (OSSN).
• Conjunctival lesion pigmentation often correlates with patient complexion.
• Seborrheic keratosis is an uncommon diagnosis for conjunctival lesions.

Purpose of the Study:

• To report a rare case of pigmented conjunctival seborrheic keratosis.
• To differentiate this benign condition from malignant neoplasms.
• To describe the histopathological features of this rare presentation.

Main Methods:

• Clinical presentation of a pigmented temporal epibulbar lesion.
• Excisional biopsy for histopathological examination.
• Staining with hematoxylin-eosin and Melan-A for melanocytes and melanophages.

Main Results:

• Excisional biopsy revealed a pigmented conjunctival seborrheic keratosis, not OSSN.
• Histopathology showed no cytologic atypia, but demonstrated dendritic melanocytes and melanophages.
• Evidence of inflammation, including lymphocytic infiltration and elevated Ki67, was noted.

Conclusions:

• Pigmented conjunctival seborrheic keratosis is a rare, benign entity.
• Distinguishing it from OSSN requires careful histopathological evaluation.
• Inflammatory and cellular features can mimic malignancy in benign lesions.