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Pigmented conjunctival and scleral lesions
1Department of Ophthalmology, Mayo Clinic Jacksonville, Florida.
Mayo Clinic Proceedings
|February 1, 1994
Summary
Conjunctival and scleral pigmentations have diverse causes and require careful diagnosis. Early detection and biopsy of suspicious lesions, like primary acquired melanosis, are crucial for managing potential melanoma.
Area of Science:
- Ophthalmology
- Dermatology
- Oncology
Background:
- Pigmented lesions of the conjunctiva and sclera present a broad differential diagnosis.
- These lesions originate from melanocytes or nonmelanocytes and include congenital melanosis, conjunctival nevi, acquired melanosis, and melanomas.
Purpose of the Study:
- To review the causes of conjunctival and scleral pigmentations.
- To discuss diagnostic and therapeutic strategies for suspicious pigmented lesions.
- To characterize ocular pigmented lesions through clinical descriptions and illustrations.
Main Methods:
- Literature review and personal experience synthesis.
- Analysis of clinical descriptions and illustrations of ocular lesions.
- Discussion of diagnostic and treatment approaches for pigmented conjunctival and scleral lesions.
Main Results:
- Pigmented lesions are classified into congenital melanosis, conjunctival nevi, acquired melanosis (primary and secondary), and conjunctival melanomas.
- Secondary acquired melanosis can result from irradiation, hormones, chemicals, or inflammation.
- Primary acquired melanosis has controversial biologic behavior and may progress to melanoma, necessitating biopsy for grading, prognosis, and treatment guidance.
Conclusions:
- Malignant potential exists in melanosis oculi, nevus of Ota, junctional nevus, compound nevus, primary acquired melanosis, and melanomas.
- Accurate diagnosis and management are essential for pigmented conjunctival and scleral lesions.
- Biopsy is recommended for primary acquired melanosis to guide treatment and prognosis.