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Ophthalmic Images |

Conjunctival Melanoma

Glenn Yiu, MD, PhD; Thomas J. Cummings, MD; Prithvi Mruthyunjaya, MD
JAMA Ophthalmol. 2014;132(12):1432. doi:10.1001/jamaophthalmol.2014.585.
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A and B, A 64-year-old man presented with an elevated, darkly pigmented left conjunctival lesion with leukoplakia and a sentinel vessel (A) with no intraocular involvement on ultrasound biomicroscopy (B). C, Excisional biopsy with double freeze-thaw cryotherapy (Video) showed pigmented epithelioid cells and prominent nucleoli consistent with a primary conjunctival melanoma.

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A and B, A 64-year-old man presented with an elevated, darkly pigmented left conjunctival lesion with leukoplakia and a sentinel vessel (A) with no intraocular involvement on ultrasound biomicroscopy (B). C, Excisional biopsy with double freeze-thaw cryotherapy (Video) showed pigmented epithelioid cells and prominent nucleoli consistent with a primary conjunctival melanoma.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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Excisional Biopsy of Pigmented Conjunctival Lesion

The pigmented conjunctival lesion was outlined with blue ink, and subconjunctival lidocaine injected to elevated the lesion. Absolute alcohol was used to loosen the corneal epithelium, and the corneal margin scored with a crescent blade. The lesion was excised using Westcott scissors and carefully dissected from the corneoscleral surface using a Tooke blade and sponge-tip applicators.Residual pigment noted at the underlying limbus was excised en bloc with a beaver blade. Double freeze-thaw cryotherapy was then applied to the limbal and conjunctival margins, which was then closed with polyglactin 910 sutures.

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