Combined Nevi of the Conjunctiva

Abstract

To report the clinical and histologic features of combined nevi of the conjunctiva, a type of nevus that is not uncommon in the skin but rarely has been reported in the conjunctiva. Methods: Conjunctival nevi and melanomas in the files of the University of California at San Francisco Eye Pathology Laboratory from 1984 to 1999 were reviewed for the presence of features of both standard nevocytic nevi and blue nevi. Clinical histories and, when available, clinical photographs were obtained. Results: Thirty combined nevi were discovered between 1984 and 1999. One case before 1984 had been incorrectly diagnosed as a junctional nevus. The dendritic and spindle-shaped blue nevus cells had been overlooked because they were not recognized as distinct from the standard nevocytic nevus cells. The recognition of blue as well as a brown color, a deep as well as a superficial component in the lesion, or a history of pigmentation since birth may help to establish the correct clinical diagnosis and prevent an unnecessarily deep surgical resection. Although growth of the lesion or "satellites" in some may favor a clinical diagnosis of melanoma, no lesions in this series were malignant. Conclusion: Despite a paucity of reports of combined nevi of the conjunctiva in the medical literature, this type of nevus, a combination of a nevocytic and a blue nevus, is common and has been overlooked in the past.

Blue nevus‐like and blue nevus‐associated melanoma: a comprehensive review of the literature

“…A combined blue nevus is a term used to describe any combination of common acquired nevi, blue nevi variants or, far less commonly, spitz nevi . Combinations with both common and cellular types of blue nevi have been described …”

Blue nevus‐like and blue nevus‐associated melanoma: a comprehensive review of the literature

“…A combined blue nevus is a term used to describe any combination of common acquired nevi, blue nevi variants or, far less commonly, spitz nevi . Combinations with both common and cellular types of blue nevi have been described …”

Conjunctival Blue Naevus in an Anophthalmic Socket

“…Jay [13] originally published a series of 229 naevi of which only 5 (2%) were histologically proven blue naevi. They can be solitary but more commonly present as combined lesions partnering with conventional conjunctival naevi [14]. Most are of “common” type, but “cellular” [15] and “epithelioid” variants [16] have been published, including 1 example that was multifocal [17].…”

Distinction of conjunctival melanocytic nevi from melanomas by fluorescence in situ hybridization

“…Areas of confluency of melanocyte nests at the epithelial/subepithelial junction, subepithelial foci of high cellularity and/or a second subpopulation of large epithelioid melanocytes (e.g. in combined melanocytic nevi) may be found and perceived as worrisome by pathologists with limited experience in the evaluation of conjunctival melanocytic proliferations 6 . However, the above‐mentioned features are usually biologically insignificant unless associated with mitotic activity, expansile tumor nodules, lack of maturation and/or in context of an asymmetric and infiltrative growth pattern.…”

“…The diagnostic problem may be related to technical reasons (small partial biopsy sample, poor quality of the histopathology) or because of the presence of an atypical histopathologic finding (e.g. subpopulation of large pleomorphic cells) 6 and/or an unusual clinical presentation (e.g. anatomic location uncommon for a nevus in a middle‐aged individual) 8,14 .…”

Blue nevus‐like and blue nevus‐associated melanoma: a comprehensive review of the literature

“…A combined blue nevus is a term used to describe any combination of common acquired nevi, blue nevi variants or, far less commonly, spitz nevi . Combinations with both common and cellular types of blue nevi have been described …”

Conjunctival Blue Naevus in an Anophthalmic Socket

“…Jay [13] originally published a series of 229 naevi of which only 5 (2%) were histologically proven blue naevi. They can be solitary but more commonly present as combined lesions partnering with conventional conjunctival naevi [14]. Most are of “common” type, but “cellular” [15] and “epithelioid” variants [16] have been published, including 1 example that was multifocal [17].…”

Distinction of conjunctival melanocytic nevi from melanomas by fluorescence in situ hybridization

“…Areas of confluency of melanocyte nests at the epithelial/subepithelial junction, subepithelial foci of high cellularity and/or a second subpopulation of large epithelioid melanocytes (e.g. in combined melanocytic nevi) may be found and perceived as worrisome by pathologists with limited experience in the evaluation of conjunctival melanocytic proliferations 6 . However, the above‐mentioned features are usually biologically insignificant unless associated with mitotic activity, expansile tumor nodules, lack of maturation and/or in context of an asymmetric and infiltrative growth pattern.…”

“…The diagnostic problem may be related to technical reasons (small partial biopsy sample, poor quality of the histopathology) or because of the presence of an atypical histopathologic finding (e.g. subpopulation of large pleomorphic cells) 6 and/or an unusual clinical presentation (e.g. anatomic location uncommon for a nevus in a middle‐aged individual) 8,14 .…”

Blue nevus‐like and blue nevus‐associated melanoma: a comprehensive review of the literature

“…A combined blue nevus is a term used to describe any combination of common acquired nevi, blue nevi variants or, far less commonly, spitz nevi . Combinations with both common and cellular types of blue nevi have been described …”

Conjunctival Blue Naevus in an Anophthalmic Socket

“…Jay [13] originally published a series of 229 naevi of which only 5 (2%) were histologically proven blue naevi. They can be solitary but more commonly present as combined lesions partnering with conventional conjunctival naevi [14]. Most are of “common” type, but “cellular” [15] and “epithelioid” variants [16] have been published, including 1 example that was multifocal [17].…”

Distinction of conjunctival melanocytic nevi from melanomas by fluorescence in situ hybridization

“…Areas of confluency of melanocyte nests at the epithelial/subepithelial junction, subepithelial foci of high cellularity and/or a second subpopulation of large epithelioid melanocytes (e.g. in combined melanocytic nevi) may be found and perceived as worrisome by pathologists with limited experience in the evaluation of conjunctival melanocytic proliferations 6 . However, the above‐mentioned features are usually biologically insignificant unless associated with mitotic activity, expansile tumor nodules, lack of maturation and/or in context of an asymmetric and infiltrative growth pattern.…”

“…The diagnostic problem may be related to technical reasons (small partial biopsy sample, poor quality of the histopathology) or because of the presence of an atypical histopathologic finding (e.g. subpopulation of large pleomorphic cells) 6 and/or an unusual clinical presentation (e.g. anatomic location uncommon for a nevus in a middle‐aged individual) 8,14 .…”