The natural history of conjunctival naevi in children and adolescents

Abstract

Objective The objective of this study is to characterise the natural history of conjunctival naevi in a paediatric and adolescent population. Methods All children and adolescents referred to Moorfields Ocular Oncology Service for evaluation between January 2015 and 2020 were included. Exclusion criteria included age >20 years old and lack of anterior segment photographs. A total of 77 patients were included with a mean age of 12 years (standard deviation: 3.9; range, 4–20). The main outcome measures were: number of conjunctival naevi that grew, changed in pigmentation, required excisional biopsy, or were histologically malignant. If there was growth, the percentage increase in size was measured. Results At their first visit, 13% of patients (10/77) were discharged to local follow-up and 10% (8/77) proceeded to excisional biopsy, four further patients underwent excisional biopsy after a period of follow-up. On histopathological assessment, 92% (11/12) of lesions were benign conjunctival naevi. One patient, who had suspicious clinical features at presentation, had conjunctival melanoma. Fifty-nine patients were followed over a median of 1.1 years (interquartile range: 1.54; range, 3 months to 4 years). Eight per cent (5/59) of conjunctival naevi enlarged in diameter by a mean percentage increase in size of 2%, whereas 5% (3/59) showed increased pigmentation and 8.5% (5/59) showed decreased pigmentation. Conclusions Growth of conjunctival naevi in children is infrequent (8%) and the large majority of those excised are benign. Because of a lack of evidence, these patients are often followed for years in ophthalmic practice. This series demonstrates that prolonged follow-up may not be necessary.

Clinical and immunohistopathological study of conjunctival melanocytic lesions in pediatric and adolescent patients. A case series

“…Some authors reported that conjunctival melanocyte lesions mainly affect girls [ 14 ], as we also recorded in the present study, but other authors stated that boys are more affected by this pathology [ 13 ]. Negretti et al (2021) pointed out that 95% of all the conjunctival nevi that they have analyzed were located on the bulbar conjunctiva, most common (53%) in the temporal horizontal quadrant, and often involving the limbus (57%) [ 13 ]. Some other authors reported that nevi are located in the interpalpebral bulbar conjunctiva (67–72%), the lacrimal caruncle (15–22%), and tarsus (0.7%) [ 15 , 16 ].…”

“…Recently, in 2021, a group of researchers at Moorfields Eye Hospital, London (UK), evaluated over a six-years period all children and adolescents under the age of 20 who were diagnosed with a conjunctival nevus. Their series included a total of 77 patients with a mean age of 12 years (range: four to 20 years) [ 13 ].…”

“…Literature reported that melanocytic conjunctival lesions are benign in 92% of cases, almost 8% are borderline lesions, and less than 3% are malignant tumors [ 4 ]. Negretti et al (2021) reported a conjunctival melanoma in 8% of all cases in their series [ 13 ]. In our series, we found out almost a double percentage of conjunctival melanoma, but this fact is correlated with our small number of cases.…”

“…Shields et al (2004) reported that only 10% of the conjunctival pigmented lesions from their series were excised for cosmetic reasons [ 25 ], but Negretti et al (2021) affirmed that 75% of their patients requested the excision of the lesion probably because they were mainly adolescents and were preoccupied for their facial appearance [ 13 ].…”

Conjunctival Pigmentation at the Sclerotomy Site following 23 G Vitrectomy with Silicone Oil Injection

“…Conjunctival pigmentation can occur following traumatic scleral tear repair or following microincisional vitreous surgery [1][2][3]. Such pigmentations can also be congenital or acquired following melanoma, drug induced, or other systemic illnesses [4][5][6][7].…”