Progression of Primary Acquired Melanosis With Atypia During Pregnancy

Figure 1. Clinical photographs. A, Pigmented area of the right temporal bulbar conjunctiva prior to the first course of treatment. Arrow indicates biopsy site shown in Figure 2A. B, The pigmented area regressed following incisional biopsy and after completion of the first course of mitomycin C. C, Increase in the size of the pigmented area before the second course of mitomycin C. Arrow indicates biopsy site shown in Figure 2B. D, The pigmented area again regressed after incisional biopsy and completion of the second course of mitomycin C. E, The lesion showed a definite increase in size when the patient was followed up at 14 weeks' gestation. Arrow indicates biopsy site shown in Figure 2C. F, Significant improvement in the wound site and in the appearance of the pigmented area 1 month after childbirth, following excisional biopsy and cryotherapy. Arrow indicates biopsy site shown in Figure 2E.

Figure 2. Histologic findings. A, Initial biopsy specimen from the pigmented area in Figure 1A showing atypical melanocytes within the lower half of the conjunctival epithelium (arrows), considered to be primary acquired melanosis with moderate atypia (hematoxylin-eosin, original magnification ×100). B, A similar appearance is seen in the repeated biopsy (from the area in Figure 1C) performed prior to the second course of mitomycin C (hematoxylin-eosin, original magnification ×100). Arrows indicate atypical melanocytes considered to amount to primary acquired melanosis with moderate atypia. C, Biopsy specimen from the area shown in Figure 1E, with almost confluent nests of atypical melanocytes along the epithelium, considered to be melanoma in situ (hematoxylin-eosin, original magnification ×100). D, Staining for melan A on the tissue shown in C also shows occasional positive cells in the stroma, suspicious of early invasion (arrows) (original magnification ×100). E, Biopsy specimen of the area in C following treatment. There was no obvious melanocytic process in the hematoxylin-eosin–stained section (original magnification ×40). F, Immunohistochemical staining showed an area with increased melanocytes within the epithelium (arrows), considered to be primary acquired melanosis with moderate atypia (melan A, original magnification ×40).