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Clinical characterization of primary acquired melanosis
1Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT 06520-8061, USA.
Purpose:
Primary acquired melanosis (PAM) is the name applied to flat, speckled, brown lesions of the conjunctival epithelium. Because there have been reports that many of these lesions progress to melanoma, biopsy of all PAM lesions, regardless of size, is recommended. This study was undertaken to determine the prevalence of PAM, provide a clinical description of the condition, and determine which factors are associated with its presence.
Methods:
One hundred forty-six consecutive patients, who were outpatients at a corneal and external diseases service, who had no known non-European ancestry, and who were older than 10 years of age underwent careful slit lamp examination.
Results:
The prevalence of PAM in the study population was 36%. Contrary to earlier reports, PAM is prevalent in young adults as well as in older patients. The presence of PAM was associated with southern European ancestry (P = 0.01), dark brown hair (P = 0.01), facial nevi (P = 0.03), pingueculae or pterygia (P = 0.01), hypertension (P = 0.02), cigarette smoking (P = 0.02), and the absence of ocular surface disease (P = 0.02).
Conclusions:
Because PAM is common, its transformation to conjunctival melanoma must be extremely rare, and biopsy of all PAM lesions is unwarranted. In the absence of known clinical risk factors for progression to melanoma, interim recommendations are made to perform biopsy only of those lesions that are widespread, large, thickened, dark, palpebral, unusually vascular, or progressive.
Insights
Primary acquired melanosis (PAM) is common, affecting 36% of patients. Its transformation to melanoma is rare, making routine biopsies of all PAM lesions unnecessary. Biopsy is recommended only for specific concerning lesion characteristics.
Area of Science:
- Ophthalmology
- Dermatology
- Oncology
Background:
- Primary acquired melanosis (PAM) presents as flat, speckled, brown conjunctival lesions.
- Previous reports suggested a high risk of progression to melanoma, advocating for routine biopsies.
Purpose of the Study:
- Determine the prevalence of PAM.
- Describe its clinical characteristics.
- Identify factors associated with PAM presence.
Main Methods:
- A slit lamp examination was performed on 146 consecutive outpatients over 10 years of age.
- Patients with known non-European ancestry were excluded.
Main Results:
- PAM prevalence was 36%, found in both young and older adults.
- Associations included southern European ancestry, dark hair, facial nevi, pingueculae/pterygia, hypertension, smoking, and absence of ocular surface disease.
Conclusions:
- PAM is common, but malignant transformation to conjunctival melanoma is rare.
- Routine biopsy of all PAM lesions is unwarranted.
- Biopsy should be reserved for lesions that are widespread, large, thickened, dark, palpebral, vascular, or progressive.