Criteria for Management of Melanosis

Usefulness of a Red Chromagen in the Diagnosis of Melanocytic Lesions of the Conjunctiva

“…Patients with these lesions had been advised to undergo radical surgical interventions, including exenteration. Zimmerman 9 argued against excessive surgical interventions based on clinical appearance and instead proposed that these MLs be classified on the basis of their histologic features. Zimmerman and Sobin 10 coined the term acquired melanosis and divided the classification into 2 stages: benign acquired melanosis and cancerous acquired melanosis.…”

“…At present, most ophthalmic pathologists in North America, including our group, follow the histologic classification proposed by Zimmerman of PAM occurring without or with atypia, which may be mild, moderate, or severe. 9,10…”

Usefulness of a Red Chromagen in the Diagnosis of Melanocytic Lesions of the Conjunctiva

“…Patients with these lesions had been advised to undergo radical surgical interventions, including exenteration. Zimmerman 9 argued against excessive surgical interventions based on clinical appearance and instead proposed that these MLs be classified on the basis of their histologic features. Zimmerman and Sobin 10 coined the term acquired melanosis and divided the classification into 2 stages: benign acquired melanosis and cancerous acquired melanosis.…”

“…At present, most ophthalmic pathologists in North America, including our group, follow the histologic classification proposed by Zimmerman of PAM occurring without or with atypia, which may be mild, moderate, or severe. 9,10…”

Finding of conjunctival melanocytic pigmented lesions within pterygium

“…For generations, PAM has been a matter of controversy with ophthalmologists, ophthalmic pathologists and dermatopathologists, who have suggested different approaches to classify conjunctival pigmented lesions 21,30–36 . Nowadays, the classification system of Folberg et al 20,21 , 23 .…”

“…For generations, PAM has been a matter of controversy with ophthalmologists, ophthalmic pathologists and dermatopathologists, who have suggested different approaches to classify conjunctival pigmented lesions. 21,[30][31][32][33][34][35][36] Nowadays, the classification system of Folberg et al 20,21,23 is easier to use and more meaningful to ophthalmologists. Therefore, for pathologists and ophthalmologists, three important facts must be considered: (i) the risk for the development of invasive melanoma is directly related to the presence and degree of atypia: in the series of Folberg et al, 20 none of the lesions without atypia progressed to invasive melanoma, whereas 46% of those with atypia did; the lesions with atypia, exhibiting intraepithelial pagetoid extension, have a 90% chance of developing into invasive melanoma; 22 (ii) clinical features alone are insufficient for determining which lesions are atypical; [37][38][39] (iii) patients with primary acquired melanosis should be monitored continually, although not all recurrences of pigmentation are melanoma.…”

Targeting of the MAPK and AKT pathways in conjunctival melanoma shows potential synergy

“…Most CM originate in primary acquired melanosis (PAM) with atypia, while a small proportion arises from a preexisting nevus or de novo [ 8 , 9 ]. The term “PAM”, created by Zimmerman [ 10 ], is used to describe the appearance of conjunctival pigmentation at some time after birth. PAM occurs with or without atypia: PAM without atypia consists of an increased amount of melanin pigment in the basal layer of the epithelium and/or melanocytic hyperplasia [ 11 ], and generally does not develop into melanoma.…”

Usefulness of a Red Chromagen in the Diagnosis of Melanocytic Lesions of the Conjunctiva

“…Patients with these lesions had been advised to undergo radical surgical interventions, including exenteration. Zimmerman 9 argued against excessive surgical interventions based on clinical appearance and instead proposed that these MLs be classified on the basis of their histologic features. Zimmerman and Sobin 10 coined the term acquired melanosis and divided the classification into 2 stages: benign acquired melanosis and cancerous acquired melanosis.…”

“…At present, most ophthalmic pathologists in North America, including our group, follow the histologic classification proposed by Zimmerman of PAM occurring without or with atypia, which may be mild, moderate, or severe. 9,10…”

Finding of conjunctival melanocytic pigmented lesions within pterygium

“…For generations, PAM has been a matter of controversy with ophthalmologists, ophthalmic pathologists and dermatopathologists, who have suggested different approaches to classify conjunctival pigmented lesions 21,30–36 . Nowadays, the classification system of Folberg et al 20,21 , 23 .…”

“…For generations, PAM has been a matter of controversy with ophthalmologists, ophthalmic pathologists and dermatopathologists, who have suggested different approaches to classify conjunctival pigmented lesions. 21,[30][31][32][33][34][35][36] Nowadays, the classification system of Folberg et al 20,21,23 is easier to use and more meaningful to ophthalmologists. Therefore, for pathologists and ophthalmologists, three important facts must be considered: (i) the risk for the development of invasive melanoma is directly related to the presence and degree of atypia: in the series of Folberg et al, 20 none of the lesions without atypia progressed to invasive melanoma, whereas 46% of those with atypia did; the lesions with atypia, exhibiting intraepithelial pagetoid extension, have a 90% chance of developing into invasive melanoma; 22 (ii) clinical features alone are insufficient for determining which lesions are atypical; [37][38][39] (iii) patients with primary acquired melanosis should be monitored continually, although not all recurrences of pigmentation are melanoma.…”

Targeting of the MAPK and AKT pathways in conjunctival melanoma shows potential synergy

“…Most CM originate in primary acquired melanosis (PAM) with atypia, while a small proportion arises from a preexisting nevus or de novo [ 8 , 9 ]. The term “PAM”, created by Zimmerman [ 10 ], is used to describe the appearance of conjunctival pigmentation at some time after birth. PAM occurs with or without atypia: PAM without atypia consists of an increased amount of melanin pigment in the basal layer of the epithelium and/or melanocytic hyperplasia [ 11 ], and generally does not develop into melanoma.…”

Usefulness of a Red Chromagen in the Diagnosis of Melanocytic Lesions of the Conjunctiva

“…Patients with these lesions had been advised to undergo radical surgical interventions, including exenteration. Zimmerman 9 argued against excessive surgical interventions based on clinical appearance and instead proposed that these MLs be classified on the basis of their histologic features. Zimmerman and Sobin 10 coined the term acquired melanosis and divided the classification into 2 stages: benign acquired melanosis and cancerous acquired melanosis.…”

“…At present, most ophthalmic pathologists in North America, including our group, follow the histologic classification proposed by Zimmerman of PAM occurring without or with atypia, which may be mild, moderate, or severe. 9,10…”

Finding of conjunctival melanocytic pigmented lesions within pterygium

“…For generations, PAM has been a matter of controversy with ophthalmologists, ophthalmic pathologists and dermatopathologists, who have suggested different approaches to classify conjunctival pigmented lesions 21,30–36 . Nowadays, the classification system of Folberg et al 20,21 , 23 .…”

“…For generations, PAM has been a matter of controversy with ophthalmologists, ophthalmic pathologists and dermatopathologists, who have suggested different approaches to classify conjunctival pigmented lesions. 21,[30][31][32][33][34][35][36] Nowadays, the classification system of Folberg et al 20,21,23 is easier to use and more meaningful to ophthalmologists. Therefore, for pathologists and ophthalmologists, three important facts must be considered: (i) the risk for the development of invasive melanoma is directly related to the presence and degree of atypia: in the series of Folberg et al, 20 none of the lesions without atypia progressed to invasive melanoma, whereas 46% of those with atypia did; the lesions with atypia, exhibiting intraepithelial pagetoid extension, have a 90% chance of developing into invasive melanoma; 22 (ii) clinical features alone are insufficient for determining which lesions are atypical; [37][38][39] (iii) patients with primary acquired melanosis should be monitored continually, although not all recurrences of pigmentation are melanoma.…”

Targeting of the MAPK and AKT pathways in conjunctival melanoma shows potential synergy

“…Most CM originate in primary acquired melanosis (PAM) with atypia, while a small proportion arises from a preexisting nevus or de novo [ 8 , 9 ]. The term “PAM”, created by Zimmerman [ 10 ], is used to describe the appearance of conjunctival pigmentation at some time after birth. PAM occurs with or without atypia: PAM without atypia consists of an increased amount of melanin pigment in the basal layer of the epithelium and/or melanocytic hyperplasia [ 11 ], and generally does not develop into melanoma.…”