[Blue nevi of the conjunctiva]

A 54-year-old man presented with multifocal pigmentations of the left bulbar and palpebral conjunctiva. He had first noticed these changes 5 years ago without any evidence of progression. The pigmented lesions were located in the plica, caruncle, the lower fornix and the mucocutaneous junction of the lower lid. The right cornea showed a focal superficial scar paracentrally due to a herpes simplex keratitis in 1970. Visual acuity was 20/20, otherwise the eyes were unremarkable. Biopsies were performed in all areas. One year after surgery, there was no recurrence of the lesions.

Histopathologically, the conjunctival epithelium is essentially unremarkable. The substantia propria display mostly uniformly pigmented spindle-shaped melanocytic cells. Many cells contain coarsely clumped melanin granules. Other areas reveal poorly pigmented to unpigmented melanocytic cells, some of them with Schwannian features. Intranuclear vacuoles are commonly present. The tumor cells are often located in stromal areas displaying increased amounts of collagen. A few polyhydral melanophages are present within the lesion.

Biopsy A (plica)--blue nevus with areas of cellular blue nevus. Biopsy B (caruncle)--cellular blue nevus. Biopsy C (lower fornix)--cellular blue nevus. Biopsy D (mucocutaneous junction of left lower lid)--Blue nevus.