Conjunctival nevi clinical features and therapeutic outcomes

Ophthalmology. 2010 Jan;117(1):35-40. doi: 10.1016/j.ophtha.2009.06.018. Epub 2009 Nov 5.

Abstract

Objective: To determine the epidemiology and the clinical and therapeutic outcomes of conjunctival nevi and to identify the clinical variables statistically associated with operative excision.

Design: Prospective, observational, noncomparative case series.

Participants: Two hundred fifty-five patients with the clinical diagnosis of conjunctival nevus.

Methods: Consecutive cases of conjunctival nevi managed at a single institution were studied to identify the clinical risk factors for operative excision.

Main outcome measures: Reasons for operative excision.

Results: Of the 255 patients who were periodically observed for a mean of 5.3 years (range, 1-11), nevi were clinically diagnosed in 140 females and 115 males and modified operative excision was performed in 75 patients (29%). The decision of operative excision was made by the surgeon in 13 cases (17%) and by the patient in 62 cases (83%). In those 13 patients, the operative decision was prompted by our concern for possible malignant transformation based on suspicious biomicroscopic features in 10 patients (13%) and photographically documented tumor growth in 3 patients (4%). For the other 62 patients who elected to undergo surgery, their reasons for excision included patient's concern for cancer in 34 cases (45%), cosmetic arguments in 9 cases (12%), and patient's request owing to lesion-induced ocular surface irritation in 19 cases (25%). Comparison between groups showed that the clinical factors at initial visit that were statistically predictive of surgical excision were the older age of the patient (P = 0.001), the largest basal tumor diameter (P<0.001), tumor location (P = 0.023), and presence of clear cysts (P = 0.013), of intrinsic vasculature (P<0.001), of prominent feeder vessels (P<0.001), and of corneal involvement (P = 0.008). None of the excised lesions showed histopathologically malignant features.

Conclusions: In our series, documented tumor growth of conjunctival nevus remained relatively a uncommon event with a incidence of 4%. Conjunctival nevi in older patients, associated with dilated feeder vessels, prominent intrinsic vasculature, and corneal involvement were more likely to be treated with operative excision.

Financial disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Conjunctival Neoplasms / epidemiology
  • Conjunctival Neoplasms / pathology*
  • Conjunctival Neoplasms / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Infant
  • Male
  • Middle Aged
  • Nevus, Pigmented / epidemiology
  • Nevus, Pigmented / pathology*
  • Nevus, Pigmented / surgery*
  • Ophthalmologic Surgical Procedures
  • Prospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome