Ocular melanomas and melanocytic lesions of the eye,☆☆

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Abstract

This article describes several melanocytic lesions of the eye. Benign and malignant lesions will be discussed as well as a review of the dysplastic nevus syndrome and its proposed association with ocular melanoma. Ocular melanomas arise from the same embryologically derived melanocytes as their cutaneous counterparts. However, ocular and cutaneous melanomas differ in many respects. The diagnosis and management of these ocular tumors rely heavily on the ophthalmologist. However, knowledge of melanocytic lesions will aid the dermatologist in detection and in proper referral of these patients. (J Am Acad Dermatol 1998;38:716-30.)

Section snippets

OCULAR ANATOMY

The eye is composed of three primary layers: the cornea and sclera; the uveal layer (iris, ciliary body, and choroid); and the retina (Fig. 1).

. Pertinent ocular anatomy.

The cornea is a transparent, avascular tissue that acts like a crystal, allowing the transmission of light into the eye and focusing it upon the retina. The sclera is the opaque fibrous outer layer that adjoins the cornea anteriorly. The episclera is the outermost layer of the sclera. The area at which the cornea and sclera meet

Benign epithelial melanosis

Benign epithelial melanosis is a common, conjunctival lesion that has been compared to cutaneous ephelides. It is often bilateral, and appears as a brown, flat, patchy area of conjunctival hyperpigmentation, commonly at the limbus. These lesions are confined to the conjunctiva and move freely over the globe. This feature may help distinguish them from other more potentially serious lesions. Benign epithelial melanosis, unlike cutaneous ephelides, has a predilection for dark-skinned persons as

Conjunctival melanoma

Conjunctival melanomas account for only 2% of all ocular melanomas. They often appear as a variably pigmented area located at the limbus. However, they may be amelanotic. These tumors may arise de novo, from a preexisting nevus, or most commonly, from a lesion of PAM. According to one study, 56% of conjunctival melanomas arose from PAM, 26% from conjunctival nevi, and 18% de novo. However, these relative percentages vary considerably in the literature.9, 19, 24 Any mass or thickened lesion

Acknowledgements

We thank Dr. Peter Donshik and Bob Fagan from the Department of Ophthalmology, University of Connecticut School of Medicine for the use of their clinical photographs in this article.

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    Reprint requests: Caron M. Grin, MD, Associate Professor of Dermatology, Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT 06032.

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