Ocular melanosis
Ocular melanosis is a blue-gray and/or brown lesion of the conjunctiva that can be separated into benign conjunctival epithelial melanosis (BCEM) and primary acquired melanosis (PAM).
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The disease is caused by an increase of melanocytes in the iris, choroid, and surrounding structures.
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The disease is caused by an increase of melanocytes in the iris , choroid , and surrounding structures.
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Overproduction of pigment can block the trabecular meshwork, leading to increased eye pressure and glaucoma.
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Overproduction of pigment by these cells can block the trabecular meshwork through which fluid drains from the eye. The increased fluid in the eye leads to increased pressure, which can lead to glaucoma .
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In humans, ocular melanosis is sometimes known as pigment dispersion syndrome.
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In humans, this is sometimes known as pigment dispersion syndrome .
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BCEM is a non-cancerous lesion more commonly found in dark-skinned individuals.
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is a non-cancerous lesion of the conjunctiva that is more commonly found in dark-skinned individuals
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PAM is a potentially cancerous lesion with a higher risk of transforming into melanoma in white persons.
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PAM is a potentially cancerous lesion of the conjunctiva, which has a higher risk of transforming into a melanoma in white persons.
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Lesions are usually described as flat, brown, and patchy areas of pigmentation.
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lesions are usually described as flat, brown, and patchy areas of pigmentation.
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PAM lesions may appear flat, brown or blue-gray, and diffuse, almost always found on only one eye.
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the lesion may also be flat, brown or blue-gray, and diffuse throughout the conjunctiva, but it is almost always only found on one eye.
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Increased fluid in the eye leads to increased pressure, which can lead to glaucoma.
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The increased fluid in the eye leads to increased pressure, which can lead to glaucoma .
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Diagnosis involves a unilateral, flat, patchy, pigmented area involving the limbus and interpalpebral conjunctiva.
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Usually unilateral, flat, patchy, pigmented area that involves the limbus (the border of the cornea and sclera ) and interpalpebral (between the eyelids) conjunctiva.
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A slit-lamp examination is used.
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Slit-lamp examination.
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Histopathological examination shows intraepithelial proliferation of conjunctival epithelial melanocytes.
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Histopathological examination that shows intraepithelial proliferation of conjunctival epithelial melanocytes.
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Determining the age when the lesion was first noticed is important, as earlier findings are more likely to be a benign nevus.
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It is very important to determine at which age the lesion was first noticed because it is more likely to be a benign nevus , or mole, the earlier it is found.
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Small lesions can be carefully watched on an annual basis.
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When lesions are small, they can be carefully watched on an annual basis.
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Medium and large-sized lesions can be treated with surgery, chemotherapy, or cryotherapy.
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for medium and large-sized lesions, we can consider surgery (excisional vs incisional biopsy), chemotherapy, or cryotherapy.
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PAM with atypia is treated with an excisional biopsy and cryotherapy.
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When a patient has PAM with atypia, an excisional biopsy with cryotherapy is recommended as the treatment.
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Diffuse lesions may be treated with cryotherapy in combination with topical mitomycin C.
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the recommendation is cryotherapy in combination with topical mitomycin C, which is a chemotherapeutic agent.
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Increasing size or size greater than 5mm may encourage biopsy.
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Increasing size or size greater than 5mm
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Involvement of conjunctiva underneath the eyelids may encourage biopsy.
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Involvement of conjunctiva underneath the eyelids
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Nodular appearance may encourage biopsy.
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Nodular appearance
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Appearance of blood vessels surrounding the patch may encourage biopsy.
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Appearance of blood vessels surrounding the patch
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Previous history of melanoma may encourage biopsy.
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Previous history of melanoma
PAM is a potentially cancerous lesion with a higher risk of transforming into melanoma in white persons, and nearly 75% of conjunctival melanomas occur in the setting of PAM.
| Ocular melanosis | |
|---|---|
| Other names | Ocular melanocytosis or Melanosis oculi or Nevus of Ota |
| Specialty | Ophthalmology |
Ocular melanosis (OM) is a blue-gray and/or brown lesion of the conjunctiva that can be separated into benign conjunctival epithelial melanosis (BCEM) and primary acquired melanosis (PAM), of which the latter is considered a risk factor for uveal melanoma.[1] The disease is caused by an increase of melanocytes in the iris, choroid, and surrounding structures. Overproduction of pigment by these cells can block the trabecular meshwork through which fluid drains from the eye. The increased fluid in the eye leads to increased pressure, which can lead to glaucoma. In humans, this is sometimes known as pigment dispersion syndrome.[2]
BCEM, also referred to as conjunctival hypermelanosis, complexion-associated melanosis, or racial melanosis, is a non-cancerous lesion of the conjunctiva that is more commonly found in dark-skinned individuals (over 90% of lesions are found in black persons and around 5% in white persons).[1] It is due to excess production of melanin in the setting of a normal number of melanocytes in the conjunctiva. It appears very early in life and the pattern does not seem to change upon reaching adulthood. There can be asymmetrical involvement of the eyes, and lesions are usually described as flat, brown, and patchy areas of pigmentation.[3]
PAM is a potentially cancerous lesion of the conjunctiva, which has a higher risk of transforming into a melanoma in white persons. Nearly 75% of all melanomas that arise from the conjunctiva have been found to have occurred in the setting of PAM.[4] It is different from BCEM because there is a proliferation, or an increase in the number of melanocytes, which is attributed to greater risk of neoplasia formation. However, PAM may occur without atypia, which has no risk of malignant transformation, or with atypia. It is very important to determine at which age the lesion was first noticed because it is more likely to be a benign nevus, or mole, the earlier it is found. It may appear similar to BCEM since the lesion may also be flat, brown or blue-gray, and diffuse throughout the conjunctiva, but it is almost always only found on one eye.[5]
Diagnosis
- Usually unilateral, flat, patchy, pigmented area that involves the limbus (the border of the cornea and sclera) and interpalpebral (between the eyelids) conjunctiva.[5]
- Slit-lamp examination.
- Histopathological examination that shows intraepithelial proliferation of conjunctival epithelial melanocytes.[1]
- Features that may encourage the ophthalmologist to biopsy the lesion include, but are not limited to:[6]
- Increasing size or size greater than 5mm
- Involvement of conjunctiva underneath the eyelids
- Nodular appearance
- Appearance of blood vessels surrounding the patch
- Previous history of melanoma
Treatment
There are a few management and treatment strategies for PAM. When lesions are small, they can be carefully watched on an annual basis. It is important to compare pictures year to year. However, for medium and large-sized lesions, we can consider surgery (excisional vs incisional biopsy), chemotherapy, or cryotherapy.[4]
When a patient has PAM with atypia, an excisional biopsy with cryotherapy is recommended as the treatment. For some patients with diffuse lesions, surgery is not an option. In these cases, the recommendation is cryotherapy in combination with topical mitomycin C, which is a chemotherapeutic agent.[1][7]
- 1 2 3 4 Salmon, John F. (2020). Kanski's clinical ophthalmology: a systematic approach (Ninth ed.). Edinburgh. ISBN 978-0-7020-7713-5. OCLC 1131846767.
{{cite book}}: CS1 maint: location missing publisher (link) - ↑ Gelatt, Kirk N., ed. (1999). Veterinary Ophthalmology (3rd ed.). Lippincott, Williams & Wilkins. ISBN 0-683-30076-8.
- ↑ Shields, Carol L; Shields, Jerry A (January 2004). "Tumors of the conjunctiva and cornea". Survey of Ophthalmology. 49 (1): 3–24. doi:10.1016/j.survophthal.2003.10.008. PMID 14711437.
- 1 2 Shields, Jerry A.; Shields, Carol L.; Mashayekhi, Arman; Marr, Brian P.; Benavides, Raquel; Thangappan, Archana; Phan, Laura; Eagle, Ralph C. (December 2007). "Primary acquired melanosis of the conjunctiva: Experience with 311 eyes". Transactions of the American Ophthalmological Society. 105: 61–72. ISSN 0065-9533. PMC 2258121. PMID 18427595.
- 1 2 Laird, Philip W.; Woodward, Maria A.; Williams, John G.; Lee, W. Barry; Grossniklaus, Hans E. (November 2012). "Cystic Benign Melanosis of the Conjunctiva". Cornea. 31 (11): 1273–1277. doi:10.1097/ICO.0b013e31823d1ec4. ISSN 0277-3740. PMC 3467456. PMID 23044615.
- ↑ "Primary Acquired Melanosis". NHS Greater Glasgow and Clyde. Retrieved 2021-03-10.
- ↑ "Conjunctival Pigmented Lesions: Diagnosis and Management". American Academy of Ophthalmology. 2013-09-01. Retrieved 2021-03-10.