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S. E. Coupland, K. U. Loeffler, N. Leonard, B. E. Damato; Conjunctival Melanocytic Lesions: Re-Appraisal of Terminology and Proposal for a Scoring System for Conjunctival Melanocytic Intraepithelial Neoplasia (C-MIN). Invest. Ophthalmol. Vis. Sci. 2010;51(13):847.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the classification, grading and staging of conjunctival melanocytic lesions.
We have audited our experience with conjunctival melanomas, using a novel mapping system. We have also reviewed 44 cases of conjunctival melanocytic intra-epithelial neoplasia (C-MIN), conventionally termed conjunctival "primary acquired melanosis" with and without with atypia. To improve objectivity in the reporting of C-MIN, we proposed a scoring system based on: pattern of melanocytic infiltration; density of melanocytes; and degree of cellular atypia. These cases were evaluated independently by 3 pathologists.
The term ‘conjunctival melanosis’ should be used only to describe the slit-lamp appearance of hyperpigmentation. Histologically, this abnormality should be categorized as ‘hypermelanosis’ or ‘melanocytosis’. Hypermelanosis can either be primary or secondary to ocular or systemic disease. Benign melanocytosis comprises conjunctival melanocytic hyperplasia and various forms of naevus. Malignant melanocytosis is essentially melanoma, which is primary ("in situ" or invasive), secondary (i.e., spreading to conjunctiva from adjacent tissues) or rarely metastatic (i.e., from distant sites in the body). The C-MIN scoring system has been validated with good reproducibility in collaboration with 2 other pathologists. High C-MIN scores essentially represent melanoma in situ, for which there will now be a stage (pTis) in the 7th Edition of the TNM staging system for conjunctival melanomas.
We have suggested revisions in the terminology of the classification of conjunctival melanocytic proliferations, and improved the grading and staging of conjunctival melanocytic intra-epithelial neoplasia/melanoma. These developments should be useful in treatment and research.
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