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Incidence of Primary Acquired Melanosis Within Pterygium Specimens: A 13-Year Retrospective Study in a Canadian
Judy Gaffar1, Moncef Berkache1, Kenan Bachour1
1Ophthalmology Department, University of Montreal, Montreal, Quebec, Canada; and.
Purpose:
Primary acquired melanosis (PAM) and pterygia are ocular surface lesions associated with sun exposure, with distinct clinical and histopathological features. This study aims to determine the incidence of PAM within pathology specimens of presumed benign pterygium cases at a tertiary center in Montreal.
Methods:
A retrospective cohort study of all consecutive patients undergoing pterygium excision at a tertiary care center between 2010 and 2023 was performed. Pathology reports of excised pterygium samples were reviewed, with data collected on age, sex, and histopathological findings. Ethics approval was obtained from the institutional review board, and no patients were excluded.
Results:
Among 1695 excised pterygia, 1277 (75.3%) specimens were submitted for pathology. Most were confirmed as pterygia (1230 samples, 96%). There were 40 unexpected findings (3.2%) including nevus or melanosis (13 cases), Salzmann nodules (5 cases), and ocular surface squamous neoplasia (4 cases). Two cases of PAM were identified: one with atypia in a 68-year-old French-Canadian man and another with no atypia in a 74-year-old Greek man.
Conclusions:
The low incidence of PAM observed highlights its rarity in presumed benign pterygium specimens. However, the identification of PAM with atypia emphasizes the need for routine pathological evaluation of all excised pterygia, even in the absence of clinical suspicion, due to the significant differences in management required for PAM.
Insights
Primary acquired melanosis (PAM) is rare in pterygium surgery specimens, with only two cases found. Routine pathology is crucial, especially when PAM with atypia is suspected, to guide appropriate patient management.
Area of Science:
- Ophthalmology
- Dermatology
- Pathology
Background:
- Primary acquired melanosis (PAM) and pterygia are ocular surface lesions linked to sun exposure.
- These conditions have distinct clinical and histopathological characteristics.
Purpose of the Study:
- To determine the incidence of PAM in pathology specimens from presumed benign pterygium cases.
- To assess unexpected findings in pterygium excisions at a tertiary care center.
Main Methods:
- A retrospective cohort study analyzed 1695 pterygium excisions between 2010 and 2023.
- Pathology reports of 1277 excised specimens were reviewed for histopathological findings.
- Data collected included patient age, sex, and diagnostic outcomes.
Main Results:
- Of 1277 analyzed specimens, 1230 (96%) were confirmed as pterygia.
- Unexpected findings occurred in 40 cases (3.2%), including nevus/melanosis (13), Salzmann nodules (5), and ocular surface squamous neoplasia (4).
- Two cases of PAM were identified: one with atypia and one without.
Conclusions:
- The incidence of PAM in presumed benign pterygium specimens is low.
- The presence of PAM with atypia underscores the importance of routine pathological evaluation for all excised pterygia.
- Pathological assessment is vital for accurate diagnosis and management, even without clinical suspicion.
