It is most often seen in the lower labial gingiva of tobacco users. Most types of acquired melanosis remain benign, but if pam is associated with. Pdf xeroderma pigmentosum is a rare autosomal recessive dermatosis. The term primary acquired melanosis pam was adopted by the world health organization in 1980 representing flat, brown, intraepithelial conjunctival lesions, in its international histological. Dr jakobiec takes issue with our term hypermelanosis, maintaining that melanosis should suffice, since the conjunctiva is normally nonpigmented.
The management of primary acquired melanosis pam and conjunctival melanoma is controversial and widely variable, in large part due to the. Most easily it is found in caucasians, due to their lack of. Products purchased from 3rd party sellers are not guaranteed by the publisher for quality, authenticity, or access to any online entitlements included with the product. In 2008, we suggested that it would be more precise for histopathologists to differentiate between conjunctival melanocytic intraepithelial neoplasia cmin and.
Primary acquired melanosis of the conjunctiva pam is a potentially serious melanocytic lesion that can lead to the development of melanoma. Clinical features of benign vs malignant conjunctival. Conjunctival primary acquired melanosis is the most important precursor of conjunctival malignant melanoma. In this condition, the melanocytes are increased in number but have a normal appearance and are in their normal location in the deepest layer of the epithelium. A complexion melanosis appearing as diffuse conjunctival pigmentation in a pigmented individual. Management of primary acquired melanosis, nevus, and. It involves conditions that can be congenital or ac quired. Secondary acquired conjunctival melanosis resulting from. Conjunctival melanosis is a term used to describe a variety of melanocytic lesions of the conjunctiva. Dramatic regression of conjunctival and corneal acquired. It is recommended that intraepithelial melanocytic proliferation be adopted for histopathologic diagnosis.
Multifocal amelanotic conjunctival melanoma and acquired. Progression of conjunctival primary acquired melanosis. Classification of conjunctival melanocytic proliferations, as used by ophthalmologists, is unique to this anatomic location and has been a subject of ongoing debate and critique. Reese was the first to classify pam of the conjunctiva as either precancerous or cancerous melanosis on the basis of clinicopathological findings9. Dataset for the histopathological reporting of conjunctival melanoma. Management of primary acquired melanosis, nevus, and conjunctival melanoma andrew kao, md, armin afshar, md, michele bloomer, md, and bertil damato, md, phd photo courtesy of lynn e. Dataset for the histopathological reporting of conjunctival. Primary acquired melanosis pam is an acquired pigmentation of the conjunctival epithelium. Conjunctival melanoma arising from primary acquired. Finger, md description malignant melanomas can start as a nevusfreckle or arise as newly formed conjunctival pigmentation called primary acquired melanosis pam. Melanocytic lesions clinically present as flat or nodular and it is in this way this. The nomenclature of primary acquired melanosis is not used. Conjunctival tumors can display either benign or malignant features.
Conjunctival pam is often precancerous and leads to lifethreatening malignant melanoma. Multifocal primary conjunctival melanomas are associated with a higher rate of recurrence and metastatic death, than unifocal tumours, principally at favourable site locations. Clinical characterization of primary acquired melanosis. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a pdf plugin installed and enabled in your browser. B primary acquired melanosis manifesting as a discrete patch of conjunctival pigment. These proposals for the reporting of conjunctival melanoma and melanosis should be. As a result orbital exenteration was required in three cases. Conjunctival melanoma arising from primary acquired melanosis. If there is a larger quantity than normal of pigment in the tissues of the eye, the condition is referred to as melanosis bulbi melanosis oculi or primary acquired melanosis when on the conjunctival epithelium and limbus. Clinical and histopathological features of four cases of multifocal amelanotic malignant melanoma of the conjunctiva in association with acquired melanosis sine pigmento are reported. The other melanocytic lesions of the ocular adnexa include nevi and malignant melanoma 2. However, a number of other lesions have a similar appearance but a different source, such as pigment deposits from. This definition includes the ephelis or freckle, so called complexionassociated conjunctival pigmentation, and benign acquired melanosis because the three entities may be indistinguishable clinically and under the microscope.
Conjunctival primary acquired melanosis pam is a painless flat brown spot on the eye that might superficially look like a freckle. Pigmented lesions that arise from the conjunctiva include nevus, complexionassociated melanosis cam, primary acquired melanosis pam, and malignant melanoma. Melanosis at the us national library of medicine medical subject headings mesh. C nevus shown as a slightly elevated pigmented lesion with intraepithelial cysts. Benign conjunctival melanocytic intraepithelial neoplasia is also known as primary acquired melanosis pam without atypia or melanocytic intraepithelial neoplasia without atypia. Pdf premalignant melanosis of the conjunctiva and the cornea in. Otherwise patients with a dark complexion who have incidental pigmentation of the conjunctiva, benign melanosis will be included in the group.
Clinical features of pigmented conjunctival lesions. This is a pdf file of an unedited manuscript that has been accepted for publication. Ophthalmic pearls oncology conjunctival pigmented lesions. The code is valid for the year 2020 for the submission of hipaacovered transactions. Cystic benign melanosis, a unique conjunctival lesion, should be differentiated from cystic nevus and primary acquired melanosis pam. Smokers melanosis is seen with the naked eye as a brown to black pigmentation of the oral tissue i. Sotereanos, dmd, mst conjunctival melanosis is a term used to describe a variety of melanocytic lesions of the conjunctiva. As seen below, primary acquired melanosis typically affects one eye, in read more. A comparison is made to familiarize dermatologists and ophthalmologists with these differences. Cystic benign melanosis cbm, which is reported here, has features of racial melanosis, cystic nevus, and pam but it is histopathologically distinct. The term primary acquired melanosis pam was adopted by the world health organization in 1980 representing flat, brown, intraepithelial conjunctival lesions, in its international histological classification of tumours 6.
Combination topical therapy for conjunctival primary. When it is associated with cellular atypia it can lead to the developement of melanoma. Conjunctival pigmented lesions college of optometrists. We apply mmc topically directly after an excision as 2times. Cam, also known as racial melanosis, is a benign lesion found among darkly pigmented individuals. Primary acquired melanosis pam with atypia and conjunctival malignant melanoma mm affect mostly middleaged white people. Melanosis without atypia is diagnosed under two circumstances. Differential diagnosis of these lesions is difficult and there is much confusion in the literature regarding their. Conjunctival primary acquired melanosis and melanoma.
The nomenclature and the clinical and pathologic features of cutaneous and conjunctival melanomas are different. This conjunctival melanoma likely developed from primary acquired melanosis pam with atypia and then grew onto the superficial surface of the cornea. We illustrate the utility of combination topical therapy with adjunctive cryotherapy to treat extensive eyelid and conjunctival lesions. Primary acquired melanosis pam is an acquired pigmentation of the conjunctival epithelium, a preinvasive pigmented lesion. The absence of conjunctival pigmentation in this extremely rare combination of lesions prevented early diagnosis and clinical monitoring. There are no published size criteria for the clinical diagnosis of pam 9, although in one large series 11 pam extended for a mean of 3 clock hours, ranging from 1 to. Conjunctival primary acquired melanosis wills eye hospital. Since 2008 we started to apply mmc in the treatment of primary acquired melanosis pam and dysplastic nevi. Congenital melanosis definition of congenital melanosis.
In a previous case report of cbm, hutchinson et al reported bilateral circumferential perilimbal cbm in twins 7. The management of conjunctival melanoma is difficult because of the rarity of the disease. A,b benign epithelial melanoses of the conjunctiva. Jan 06, 2017 the same argument can be used for the term conjunctival melanoma in situ, which has been controversial for years, but really should be recognized and treated as such. Pam appears as unilateral, patchy areas of flat, brown pigmentation within the superficial conjunctiva. Melanocytic lesions of the conjunctiva archives of. The pigmented lesions were located on the bulbar conjunctiva adjacent the limbus. As seen below, primary acquired melanosis typically affects one eye, in. May 01, 2016 conjunctival primary acquired melanosis.
Topical mitomycin chemotherapy for conjunctival malignant. Giant conjunctival nevus in a 12yearold child giant conjunctival nevus in a 12yearold child. A juvenile case of conjunctival atypical nevus pdf. Reprinted from university of utah, peter debry, kwok li, and nick mamalis, md, ophthalmic pathology. Secondary acquired conjunctival melanosis resulting from an. Primary acquired melanosis of the conjunctiva pam is a potentially serious melanocytic lesion that can lead to the. A simple biopsy can determine whether a pigmented conjunctival tumor is a nevus, primary acquired melanosis, or conjunctival melanoma. An internet ocular pathology archive, with permission from university of utah ophthalmic pathology. The disease was too extensive for ocular conservation, therefore exenteration. Conjunctival melanosis now differentiated histologically into hypermelanosis and conjunctival melanocytic intraepithelial neoplasia cmin cases formerly classified as pam are now classified as cmin. Combination topical therapy for conjunctival primary acquire. However, a number of other lesions have a similar appearance but a different source, such as pigment deposits from silver and iron. In black patients, the melanosis tends to be pigmented more deeply at the limbus and it then fans out, decreasing in intensity toward the fornix.
This website is intended for pathologists and laboratory personnel, who understand that medical information is imperfect and must be interpreted using reasonable medical judgment. In his early comments, he remarked that many of these lesions evolved into malignant melanoma of the conjunctiva. Cam, primary acquired melanosis pam, and malignant mel anoma. To report the case of a patient who initially presented with primary acquired melanosis pam without atypia of the conjunctiva and later developed lentigo maligna of the eyelids and pam with atypia of the conjunctiva. Conjunctival melanoses are a common clinical finding of flat granular melanotic pigmentation of the conjunctival epithelium. He explained everything i needed to know about my issue with detail and attention, putting me at ease and giving me confidence to. Progression of conjunctival primary acquired melanosis pam. In 1980, the who proposed the term pam to describe this disorder. B primary acquired melanosis manifesting as a discrete patch of.
Melanosis is a form of hyperpigmentation associated with increased melanin. He explained everything i needed to know about my issue with detail and attention, putting me at ease and giving me confidence to handle this problem for the rest of my life. Review of the literature jerman m alqahtani, md background. There are no published size criteria for the clinical diagnosis of pam, although in one large series pam extended for a mean of 3 clock hours, ranging from 1 to 12 clock hours. It is analagous to lentigo maligna of the skin and carries a risk of malignant transformation. Pigmented conjunctival cancers primary acquired melanosis. The development of this precursor of conjunctival malignant melanoma in a. Congenital melanosis definition of congenital melanosis by. The management of conjunctival melanoma is difficult because of the rarity of the. It can be found in children and adults and typically occurs on only one eye. We reserve the diagnosis for a clear increase in the number of melanocytes in a specific pattern. Conjunctival melanoma metastasis diagnosed by sentinel lymph node biopsy. Combination of imiquimod 5% cream aldara, 3m pharmaceuticals and cryotherapy for periorbital lentigo maligna with topical interferon. Melanosis is an inadequate and misleading term because it does not distinguish between conjunctival intraepithelial melanin overproduction hyperpigmentation and intraepithelial melanocytic proliferation.