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Malignant Melanoma Presenting as Pedunculated Lesion of the Caruncle

Jerry A. Shields, MD1; Renelle Pointdujour-Lim, MD1; Sara E. Lally, MD1; Ralph C. Eagle Jr, MD1; Carol L. Shields, MD1
[+] Author Affiliations
1Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
JAMA Ophthalmol. 2016;134(4):464-466. doi:10.1001/jamaophthalmol.2015.6084.
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This case report describes malignant melanoma confined to the caruncle, without evidence of primary acquired melanosis.

Conjunctival melanoma is generally a pigmented lesion that arises from primary acquired melanosis (PAM), from preexisting nevus, or de novo.1 There have been a few reported series of lesions that arise in the lacrimal caruncle, and melanoma in the caruncle is almost always an extension from adjacent PAM. Melanoma confined only to the caruncle without adjacent PAM is rare.2,3 We report a rapidly growing, pedunculated, amelanotic, ulcerated mass arising from the caruncle with no adjacent PAM. Initially, the lesion was suspected to be keratoacanthoma based on the history and clinical course. Histopathology of the excised lesion revealed malignant melanoma, confined to the caruncle, without evidence of PAM.

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Figure.
Findings on Ocular Examination, Histopathology, and Immunohistochemistry

A, Ulcerated, pedunculated, caruncular tumor. B, Proteinaceous material on the ulcerated tumor surface (hematoxylin-eosin, original magnification ×25). C, Mitotically active tumor containing anaplastic epithelioid cells (hematoxylin-eosin, original magnification ×400). D, Melanoma cells showing immunoreactivity for Melan-A (hematoxylin-eosin, original magnification ×100). E, Nuclear staining for Ki-67 reveals a high proliferative index (hematoxylin-eosin, original magnification ×50).

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