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Ophthalmic Images |

Amelanotic Conjunctival Melanoma Online Only

Mausam R. Damani, MD1; Joan M. O'Brien, MD2
[+] Author Affiliations
1University of Pennsylvania, Philadelphia
2Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia
JAMA Ophthalmol. 2016;134(1):e153568. doi:10.1001/jamaophthalmol.2015.3568.
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This Ophthalmic Image describes a case of amelanotic conjunctival melanoma in a man in his 60s.

A man in his 60s with a history of hypertension, proliferative diabetic retinopathy, and primary open-angle glaucoma presented with 6 months of right-sided bloody tearing. Examination revealed a 7 mm × 5 mm pedunculated mass extending from the conjunctiva of the right superolateral fornix (Figure). The lesion resembled a pyogenic granuloma; however, histopathological analysis was positive for markers characteristic of melanoma—S100 and Melan-A. The conjunctiva overlying the lesion showed no evidence of a precursor lesion such as primary acquired melanosis, so the possibility of metastasis to this site was explored. The patient underwent dermatological examination, whole-body positron emission tomography and computed tomography scans, colonoscopy, and orbital magnetic resonance imaging, from which no other primary mucocutaneous melanoma lesions were found. The patient was scheduled for additional excision with wide margins, cryotherapy for residual disease, and amniotic membrane grafting to prevent scar tissue formation.

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Pedunculated 7 mm × 5 mm mass extending from the superolateral fornix, found on excisional biopsy to be an amelanotic melanoma in an area without any surrounding atypia.

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