Clinical and histopathological evaluation  of 312 excised conjunctival tumors

Dębicka-Kumela, Magdalena; Karska‐Basta, Izabella; Markiewicz, Anna; Bogdali, Anna; Kowal, Joanna; Romanowska–Dixon, Bożena

doi:10.5114/ko.2019.84561

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“…In our study, malignant and premalignant tumours (MMC and PAM with atypia) were more frequently found among patients with a mean age of 60 years, than benign lesions (naevi and PAM without atypia), which occurred on average around the age of 40. This is compliant with the results of previous studies on pigmented tumours of other mucous membranes (6,7,14,(21)(22)(23)(24)(25)(26).…”

Section: Discussionsupporting

confidence: 91%

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The Evaluation of the Malignant Characteristics of Conjunctival Lesions Based on the Dermatoscopic Algorithm

et al. 2021

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Background/Aim: This study analysed the prevalence of the characteristics evaluated in dermatoscopy for melanocytic infiltrations of the conjunctiva with various degrees of malignancy. Patients and Methods: A total of 160 conjunctival pigmented lesions were studied. Each lesion was scored using dermatoscopic patterns and the characteristics of malignancy described by Kittler. Also, the Authors' own clues were added to the evaluation. Results: In melanomas, the following characteristics were identified: asymmetry of the pattern and colour, larger average number of colours, the presence of grey colour, structureless area, polymorphic vessels and feeder vessels. A pattern of black dots and a black colour was typical of malignant lesions and pre-cancerous (premalignant) lesions -primary acquired melanosis (PAM) with atypia. Cysts were observed only in the group of naevi. Conclusion: The patterns evaluated with dermatoscopy are present in pigmented lesions of the conjunctiva. There are, however, some characteristics which allow differentiation between melanoma and pigmented naevus and melanosis and also between PAM.There are several lesions that arise from the melanocytes of the conjunctiva. The most common are naevi, primary acquired melanosis (PAM) and malignant melanoma (MM). The predominant conjunctival pigmented tumour is naevus (1, 2). Naevus accounts for 28% of all conjunctival tumours and 52% of melanocytic lesions (3). It is a benign lesion, with a less than 1% (3, 4) tendency to malignant transformation. It is usually a unilateral, slightly elevated, variably pigmented lesion, with clear cysts, and feeder vessels, and is predominantly located in the bulbar conjunctiva (3). All naevi require serial observation using photographic documentation. Any changes in size, shape or colour are suspicious of malignant transformation and should be treated like melanoma. Some patients demand excision for cosmetic reasons (4, 5).PAM accounts for 11% of all conjunctival tumours and 21% of conjunctival pigmented lesions (2, 6, 7). It can be divided into melanosis with atypia and without atypia, depending on the nuclear features and growth pattern of melanocytes in the histopathological examination. The presence of atypia is associated with a very high risk (13-50%) of malignant transformation, while absence of atypia carries no risk for melanoma development (4-6). PAM with atypia is considered to be a form of melanoma in situ, similar to lentigo maligna of the skin (6, 8). PAM occurs as a flat, unilateral, brown, patchy or diffuse lesion usually in middleaged Caucasian individuals (9). It is thought that it is impossible to distinguish clinically PAM without atypia from PAM with atypia (4). PAM must be differentiated from racial melanosis, which is usually bilateral and symmetrical (6). The procedure proposed by Shields and co-workers in patients with PAM involves observation or surgical treatment in combination with cryotherapy and/or topical chemotherapy depending on the size of the lesion. In cases of very large tumours, ...

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Section: Discussionsupporting

confidence: 91%

“…Patients with melanoma from precursors demonstrate better survival compared with those arising de novo (12). CMM causes local and systemic metastases in 32% of cases within a 15-year follow-up period (5,12,14). Metastases to lymph nodes, the liver, brain, lungs and skin are the most common sites (5,8, 895 This article is freely accessible online.…”

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confidence: 99%