Ocular surface foreign bodies: novel findings mimicking ocular malignant melanoma

Maudgil, Anu; Wagner, Bart; Rundle, Paul; Rennie, I G; Mudhar, Hardeep Singh

doi:10.1038/eye.2014.177

Cited by 9 publications

(3 citation statements)

References 6 publications

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“…Blue nevi that also exhibit heavily pigmented nevus cells reveal characteristic spindle-shaped cells that may share some cellular characteristics with type II melanocytoma cells. Also, deeply pigmented foreign bodies can mimic a melanocytoma clinically [11]. …”

Section: Discussionmentioning

confidence: 99%

Melanocytoma of the Conjunctiva: Clinicopathologic Features of Three Cases

2019

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Background: Melanocytoma (magnocellular nevus) is a jet-black benign lesion histologically composed of polygonal tumor cells with small, inconspicuous nuclei and abundant cytoplasm. Melanocytomas in general are rare. Most cases occur in the optic nerve head. Conjunctival melanocytoma (magnocellular nevus) is extremely rare, and only 3 lesions of the ocular surface have been reported. Objectives: To describe the clinical and histological spectrum of conjunctival melanocytoma and discuss differential diagnoses of this rare lesion. Method: Four heavily pigmented conjunctival lesions were excised for slight tumor growth and histologically processed. The specimens were routinely stained with hematoxylin and eosin and periodic acid-Schiff. Sections were bleached and immunohistochemical stains were performed for CD68, HMB-45, S100, melanin, and Ki-67. Results: Histological examination revealed findings of a conjunctival melanocytoma in 3 cases. The fourth case was diagnosed histologically as a combined melanocytic lesion with a compound nevus and an inverted type A nevus. None of the lesions exhibited transition towards malignancy. The differential diagnoses included conjunctival melanoma, granular cell nevus, compound nevus with reactive changes, and blue nevus. Conclusions: Conjunctival melanocytic lesions suspicious for melanocytoma should be bleached to evaluate their cytologic features. CD68 can be helpful in identifying heavily pigmented melanomacrophages which may mimic a melanocytoma. As conjunctival melanocytomas are extremely rare, their pathogenesis may be different from that of other conjunctival nevi.

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Section: Discussionmentioning

confidence: 99%

Melanocytoma of the Conjunctiva: Clinicopathologic Features of Three Cases

2019

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“…The clinicopathological differential diagnosis included melanophages, pigmented foreign body material [6], migrating pigment epithelial cells from the uvea or retinal pigment epithelium (given the history of trauma to the eye 7 years previous) [7], oculo(dermal) melanocytosis [8], and blue-naevus-like metastatic melanoma [9]. Melanophages were excluded by negative CD68 immunohistochemistry.…”

Section: Case Reportmentioning

confidence: 99%

Conjunctival Blue Naevus in an Anophthalmic Socket

2017

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Purpose of the Study: To describe an unusual brown pigmented lesion of the conjunctiva in an anophthalmic socket in a 16-year-old male. Procedures: A 16-year-old male patient presented with socket irritation whilst wearing an artificial eye due to meibomian gland dysfunction. An area of flat, subepithelial, dark brown pigmentation with irregular and indistinct borders on the bulbar conjunctiva of the anophthalmic socket was seen. The patient believed it had been present for at least 2 years. His past ocular history was of childhood trauma to the right eye at the age of 9 years, and he underwent primary enucleation and hydroxyapatite orbital implant insertion at that time. Unfortunately, the implant extruded and was removed a year later. Results: An incisional biopsy of the pigmented lesion showed a conjunctival, subepithelial bland spindle cell melanocytic lesion, with uniform-sized and -shaped melanosomes. Immunohistochemistry showed the cells to express Melan A and HMB45 and they were negative for CD68 and pan-cytokeratins. The features were of a common blue naevus. Conclusion: This is the first documentation of a post-enucleation conjunctival naevus in an anophthalmic socket. We propose a pathogenesis and suggest surveillance as there is a risk of transformation to melanoma.

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“…This delayed presentation is thought to be related to granulomatous inflammation which may not occur initially because of the time related to breakdown of the graphite, clay, and waxes contained within the pencil lead [9]. Enlargement of a pigmented mass in patients who often do not have a distinct history of pencil trauma may raise concern for melanoma [2,7,10]. Preoperative imaging may be considered to help evaluate the extent and characteristics of some suspicious lesions [11].…”

Section: Introductionmentioning

confidence: 99%

Enlarging Pigmented Eyelid Mass Associated with Remote Pencil Trauma

Phelps¹,

Carlson

Meyer

2017

Ocul Oncol Pathol

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The authors present a case of a gradually enlarging pigmented mass of the upper eyelid and anterior orbit that was discovered to be the graphite tip of a pencil surrounded by macrophages bearing graphite and fibrous tissue. A 25-year-old woman with no medical history presented with a gradually enlarging pigmented lesion of her left upper eyelid. She denied any history of previous skin cancer, trauma, or previous surgery. A biopsy was performed. This revealed an encapsulated grayish, pigmented mass within the medial portion of the left upper eyelid and anterior orbit. Within the pigmented cocoon, the graphite core of a pencil (“pencil lead”) was identified. Histopathology demonstrated granulomatous inflammation with fibrosis and macrophages.

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Ocular surface foreign bodies: novel findings mimicking ocular malignant melanoma

Abstract: This report highlights the importance of careful history taking, examination, and appropriate biopsy in cases of suspected malignant melanoma, to prevent unnecessary and potentially radical treatment.

Cited by 9 publications

References 6 publications

Melanocytoma of the Conjunctiva: Clinicopathologic Features of Three Cases

Melanocytoma of the Conjunctiva: Clinicopathologic Features of Three Cases

Conjunctival Blue Naevus in an Anophthalmic Socket

Enlarging Pigmented Eyelid Mass Associated with Remote Pencil Trauma

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