Giant Conjunctival Nevus: Clinical Features and Natural Course in 32 Cases

Abstract

 

Purpose

 

To describe the clinical features, management, and outcomes of giant (>10 mm diameter) conjunctival nevus.

 

Methods

 

Retrospective case series

 

Results

 

Of 618 eyes with conjunctival nevus, 32 (5%) were classified as giant conjunctival nevus. The mean patient age at diagnosis was 34 years (median 33, range 2 - 75 years). A personal history of increase in nevus basal dimension or thickness was noted in 15 (47%) and increase in nevus color intensity in 2 cases (6%). The giant nevus involved cornea in 11 (34%), limbus in 23 (72%), bulbar conjunctiva in 31 (97%), fornix in 9 (28%), tarsus in 3 (9%), semilunar fold in 10 (31%), and caruncle in 7 (22%). The nevi had mean diameter of 16 mm (median 13, range 10 - 40) and mean thickness of 2 mm (median 2, range 0.5 - 4). On slit lamp examination, intrinsic cysts were identified in 25 (78%), intrinsic blood vessels in 26 (81%), and feeder vessels in 22 (69%) of cases. Management included excisional biopsy with cryotherapy in 23 (72%) and observation in 9 cases (28%). Amniotic membrane graft reconstruction was employed following excision in 3 cases (13%). Malignant melanoma developed within the giant nevus in 1 case after 23 years of observation. Post excisional biopsy, nevus recurrence was detected in 4 cases (17%), pseudopterygium in 1 (4%), dry eye in 1 (4%), and eyelid blepharoptosis in 1 (4%).

 

Conclusions

 

In an ocular oncology practice, giant conjunctival nevus represents 5% of conjunctival nevi. This benign tumor rarely transforms into conjunctival melanoma (n=1, 3%). Management alternatives include observation or wide excisional biopsy, cryotherapy, and reconstruction, possibly with amniotic membrane graft.

 

 

Clinical features and imaging with anterior segment optical coherence tomography (AS-OCT) of giant conjunctival nevus. (A) A 16-year-old Caucasian male demonstrated a giant conjunctival nevus with slight pigmentation superonasally, measuring 20 mm in basal diameter and 4 mm in thickness. On AS-OCT, the intralesional cysts (B) were confirmed. (C) A 48-year-old Caucasian male showed giant conjunctival nevus superotemporally, measuring 18 mm in basal diameter and 2 mm in thickness. On AS-OCT, the intralesional cysts (D) were confirmed.

 

Keywords: 474 conjunctiva • 744 tumors • 589 melanoma