Conjunctival nevi

[jjwiiwi]

I am a longtime reader of this great forum, however I haven't really posted anything...so here it goes:

How do you differentiate a conjunctival nevus from conjunctival melanoma from PAM? I was trying to read about it, but I don't think I have the right texts. Any suggestions where to look this up? Oculopath or histopath books?

Thanks!

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[Andrew_Doan]

You can read more about conjunctal nevi, melanoma, and PAM in Dr. Nerad's oculoplastics textbook: http://www.amazon.com/exec/obidos/ASIN/0323001742/bridgebooks/002-7742027-7491239

Take a look at Joseph Sassani's text on oculopathology too.

Often it's difficult to differentiate between nevi and melanoma lesions. This is why following the lesion with photographs helps. Nevi tend to be slow growing, well demarcated, and cystic on slit lamp exam. Melanoma may cause local inflammation, have indistinct margins, grow quickly, and have a sentinel blood vessel (i.e. feeder vessel). Both can be darkly pigmented.

PAM is more of a dusting of brown pigment on the conjunctival surface and is suspicious in patients with fair skin, unilateral presentation, and pigmentation on the palpebral conjunctiva. PAM needs to be followed closely and biopsied if suspicious. If the pathology denotes PAM with atypia (epithelial cells look discohesive and different than routine epithelial cells), then there is a 50% risk of malignant transformation.