Malignant Tumors of the Conjunctiva

What patient population gets primary acquired melanosis (PAM)?

fair skinned

Middle Aged, elderly

What are the two types of primary aquired melanosis (PAM)?

PAM without atypia

PAM with atypia

What is primary acquired melanosis (PAM) with atypia?

has atypical melanocyte hyperplasia

Which type of primary acquired melanosis (PAM) is considered precancerous?

primary acquired melanosis (PAM) with atypia (larger the lesion = greater risk)

What are the symptoms of primary acquired melanosis (PAM)?

none

What is the presentation of primary acquired melanosis (PAM)?

flat irregular brown lesion(s) on any part of the conj (Pal, bulb, fornix)

Unilateral 

May be uni or multi focal

What is the treatment of primary acquired melanosis (PAM)?

observation or excision

When do conjunctival melanomas present?

in 60s (they are uncommon)

How do conjunctival melanomas form?

arise from PAM atypia, conj nevus, or on own

What is the presentation of conjunctival melanomas?

pigmented elevated lesion

surrounding pigmentation

enlarged feeder vessels

Where are conjunctival melanomas commonly found?

bulbar conj

limbus

(less common on palp conj and fornix)

What is the treatment of conjunctival melanoma?

Excision with chemotherapy, cryotherapy, or radiotherapy

What patient population does Ocular Surface Squamous Neoplasia (OSSN) affect?

older adults

males (in US and Europe)

women (in Africa)

What are the risk factors for Ocular Surface Squamous Neoplasia (OSSN)?

UV exposure

fair skin

smoker

Xeroderma pigmentosum

HIV/HPV

What is Ocular Surface Squamous Neoplasia (OSSN)?

slowly progressive lesion that can be benign, premalignant, or malignant

What are the symptoms of Ocular Surface Squamous Neoplasia (OSSN)?

visible mass

occasional conjunctivitis

What is the presentation of Ocular Surface Squamous Neoplasia (OSSN)?

fleshy, gelatinous mass (looks like sessile papilloma)

enlarged feeder vessels

Where is Ocular Surface Squamous Neoplasia (OSSN) located?

interpalpebral fissure @ limbus

What is the treatment of Ocular Surface Squamous Neoplasia (OSSN)?

excision

What are the symptoms of lymphoproliferative lesions?

irritation

painless swelling

What is the presentation of lymphoproliferative lesions?

flesh colored infiltrate

rarely diffuse

no discharge

mobile

What does lymphoproliferative lesions mimic? What is the difference?

chronic conjunctivitis, except has no discharge

What age group is lymphoproliferative lesions seen in?

late adulthood

What is the treatment for lymphoproliferative lesions?

excision

chemo/cryo/radiotherapy

What is the presentation of Kaposi Sarcoma of the conj?

flat bright red lesion

no discharge

affects lashes and lids in notes

what is the treatment of kaposi sarcoma of conj?

focal radiotherapy

excision w or without cryotherapy