All Eyes on Dermoscopy: Features of Benign Conjunctival Melanocytic Lesions

Conjunctival nevi (CN) represent the majority of benign conjunctival melanocytic lesions (CML), followed by complexion-associated melanosis (CAM). Noninvasive methods like dermoscopy could be of importance to increase diagnostic accuracy in this biopsy-sensitive area. Because of the unique anatomy of the conjunctiva, dermoscopic findings differ significantly compared to the skin or other mucosae.

Our objective was to analyze epidemiological, clinical, and dermoscopic characteristics of benign conjunctival melanocytic lesions and to explore their correlation to total body nevus count (TBNC).

This retrospective study involved the collection and analysis of demographic data, patient information, and clinical and dermoscopic images from individuals with long-standing, stable, pigmented conjunctival lesions.

A total of 30 benign conjunctival melanocytic lesions in 28 patients (female/male:18/10) with a median age of 32 (range 16-68) years were evaluated. The prevalent dermoscopic pattern was a mixed, globular, homogeneous pattern (36.6%). Clear cysts were identified via dermoscopy in 60% of the lesions, and a reticular pattern was observed in all cases involving cysts (P<0.05). The presence of benign CML was associated with a low TBNC (<10) in 64.3%.

The present study provides a detailed overview of the clinical and dermoscopic characteristics of benign CML. It highlights consistent patterns such as cyst-associated reticular features and a low TBNC among affected individuals. These findings support the clinical utility of dermoscopy as a noninvasive tool for differentiating between benign and suspicious conjunctival lesions. The observed association with low TBNC may warrant increased vigilance during ocular examination in patients with few cutaneous nevi. Prospective studies with larger cohorts are needed to confirm and extend these observations.