Clinical Features Differentiating Benign From Malignant Conjunctival Tumors in Children

Abstract

IMPORTANCE Conjunctival tumors in children are usually benign and rarely malignant. OBJECTIVE To evaluate clinical features of conjunctival tumors in children by comparing benign tumors with their malignant counterparts. DESIGN, SETTING, AND PARTICIPANTS This retrospective case series reviewed 806 cases of conjunctival tumor in children (aged <21 years) who were evaluated at a tertiary referral center between November 1, 1975, and July 1, 2015. This study included 262 children who were part of a published review. MAIN OUTCOMES AND MEASURES Features of benign and malignant tumors were compared. Data were collected on patient demographics, tumor features, and specific diagnoses to determine findings related to each tumor. RESULTS Among the 806 patients with conjunctival tumor, the top 5 diagnoses included nevus (492 [61%]), benign reactive lymphoid hyperplasia (BRLH) (38 [5%]), nodular conjunctivitis (31 [4%]), dermoid (30 [4%]), and primary acquired melanosis (27 [3%]). Overall, conjunctival tumors were benign (779 [97%]) or malignant (27 [3%]), including melanoma (18 [2.2%]) and lymphoma (9 [1.1%]). The mean age at detection was 11 years for benign tumors and 14 years for malignant tumors (P = .005), with mean difference of 3 years (95% CI, 1.2-4.6). The relative frequency of any malignancy (per all conjunctival tumors) by age bracket (0-5 years, >5-10 years, >10-15 years, and >15-<21 years) was 1%, 2%, 3%, and 7%, respectively. A comparison between nevus and melanoma found differences with melanoma in the 10 to 15 years age bracket (29% vs 61%; difference of 32% [95% CI, 10%-55%];

Conjunctival Melanoma in Chinese Patients: Local Recurrence, Metastasis, Mortality, and Comparisons With Caucasian Patients

“…Experiences from other medical centers also gave credence to this finding from different perspectives. Shields et al 33 conducted a retrospective study in 806 children with conjunctival tumor. 33 It was proven that compared to nevus, a child with malignant conjunctival melanoma had a 25.3-fold increase in chances of hemorrhage in the tumor.…”

“…Shields et al 33 conducted a retrospective study in 806 children with conjunctival tumor. 33 It was proven that compared to nevus, a child with malignant conjunctival melanoma had a 25.3-fold increase in chances of hemorrhage in the tumor. And in another large series of 5002 patients with conjunctival tumors, tumor hemorrhage was a significant predictor for malignant melanoma compared with PAM lesions.…”

Overview and Classification of Conjunctival and Corneal Tumors

“…Other common tumors were primary acquired melanosis (623/5002, 12%), melanoma (612/5002, 12%), and squamous cell carcinoma (440/5002, 9%) [8]. A separate analysis of this mega-data on pediatric conjunctival tumors in 806 cases disclosed that melanocytic (492/806, 61%) followed by choristomatous tumors (65/806, 8%) were the most common tumors in this age group [9]. In the overall group, comparative analysis of patients with primary acquired melanosis versus melanoma in 1224 cases found those with melanoma more likely showing tarsal location (relative risk [RR] = 1.6), thickness >1 mm (RR = 2.8), presence of intralesional cysts (RR = 2.1), feeder vessels (RR = 2.3), intrinsic vessels (RR = 2.2), and hemorrhage (RR = 1.8) [8].…”

“…Comparative analysis of patients with conjunctival intraepithelial neoplasia versus squamous cell carcinoma in 715 cases found those with squamous cell carcinoma more likely showing greater diffuse involvement (p < 0.0001), median basal diameter (p < 0.0001) and thickness (p < 0.0001), location >1 mm from the limbus (p = 0.0228), brown pigmentation (p = 0.0264), and intrinsic vessels (p = 0.0234) [8]. Similarly, in children, nevus versus melanoma revealed melanoma more likely with greater tumor thickness (p = 0.037) and base (RR = 4.92), presence of tumor hemorrhage (RR = 25.3), and absence of intrinsic cysts (RR = 5.06), and lymphoid hyperplasia versus lymphoma revealed lymphoma more likely with larger mean basal dimension (p = 0.002) and diffuse in location vs nasal (RR = 16.5) [9].…”

“…Vascular, neural, fibrous, lipomatous, xanthomatous, metastatic, and secondary tumors of the conjunctiva are rare and together comprise approximately 10% of all conjunctival tumors [5]. For more information on those tumors, reference to major articles [1,[4][5][6][7][8][9] and textbooks [10,17,[24][25][26][27] is advised.…”