Management of pigmented conjunctival lesions

Ocul Surf. 2012 Oct;10(4):251-63. doi: 10.1016/j.jtos.2012.08.002. Epub 2012 Aug 11.


Pigmented conjunctival lesions primarily include melanoma, nevus, primary acquired melanosis (PAM), and complexion-associated melanosis. The incidence of conjunctival malignant melanoma (CMM) has significantly increased in the USA and Europe over the years, and it carries a very serious risk for metastasis and melanoma-related death. Conjunctival melanoma can arise de novo or from precursor lesions, nevus, and PAM. PAM is histologically separated into two distinct forms: PAM with atypia and without atypia. PAM with severe atypia progresses to malignant melanoma in up to 50% of cases and PAM without atypia virtually never progresses. Nevus is a benign melanocytic tumor that only rarely undergoes malignant transformation. Complexion-associated melanosis is frequently seen in more darkly pigmented individuals and does not progress to melanoma, although it can become very large. A detailed literature review on the various pigmented conjunctival lesions together with a schematic approach to diagnosis and management is presented.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Conjunctival Neoplasms / diagnosis
  • Conjunctival Neoplasms / epidemiology
  • Conjunctival Neoplasms / therapy*
  • Humans
  • Incidence
  • Melanoma / diagnosis
  • Melanoma / epidemiology
  • Melanoma / therapy*
  • Melanosis / diagnosis
  • Melanosis / epidemiology
  • Melanosis / therapy*
  • Nevus, Pigmented / diagnosis
  • Nevus, Pigmented / epidemiology
  • Nevus, Pigmented / therapy*
  • Risk Factors