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G. A. Novais, B. F. Fernandes, L. N. Santos, D. P. Cheema, L. R. de Moura, M. N. Burnier Jr; Melancytic Lesions of the Conjunctiva: A Single Center Clinical Pathological Study. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4282.
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: Melanocytic tumors of the conjunctiva represent approximately 50% of all conjunctival lesions. They can be classified according to their clinicopathological features into nevus, primary acquired melanosis (PAM) and melanoma. Although clinical and histopathological surveys on conjunctival tumors have already been reported, most of these studies come from tertiary centers where referral bias is significant. Consequently, the proportion of malignant lesions is generally overestimated. The aim of this study was to review all melanocytic conjunctival lesions from a single center and evaluate clinico-histopathological parameters.
A retrospective analysis of all cases diagnosed as conjunctival melanocytic lesions (nevus, melanoma or PAM) between 1993 and 2005 at The Henry C. Witelson Ophthalmic Pathology Laboratory and Registry, McGill University, Montreal, Canada was undertaken. Histopathological reports were reviewed in order to provide the following patient characteristics: age at diagnosis, gender, laterality and topographic location of the lesion. Cases that were sent as consultations from other centers were excluded from this particular study to avoid referral bias.
We received 10,675 ophthalmic specimens . Of those, 271 were conjunctival lesions (2.5%), with 101 classified as melanocytic. Of those, 55 (49.5%) nevus, 36 (35.6%) PAMs and 15 (17.4%) melanomas. After exclusion of referred cases, 85 lesions were included in the study: 44 (51,7%) nevus, 33 (38,8%) PAMs, and 8 (9,4%) melanomas. The most prevalent location was bulbar conjunctiva (81,1%), followed by caruncle (14,1%) and tarsal conjunctiva (4,7%). The mean age + standard deviation was 40 + 16.9 years for nevus, 41.8 +12.6 years for PAM and 70.6 + 9.5 years for melanoma. The influence of gender on the distribution was not statistically significant (p = 0.73). However, PAM occurred in a younger age in women than men (p = 0.01). Conjunctival nevi were: Compound (32,9%), subepithelial (16,4%) and junctional (2,3%). PAM were further classified into PAM with atypia (8,2%) and PAM without atypia (30,5%). PAM was the predisposing lesion in 6 (75%) of the 8 cases of conjunctival melanoma.
This study revealed that nevi of the bulbar region are the most common melanocytic lesion of the conjunctiva. The age of onset for PAM was significantly younger for women as compared to men. Moreover PAM with atypia was the most important predisposing lesion for conjunctival melanoma. In this particular study the referral bias did not significantly alter the final results.
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