Image Letter

A Growing Conjunctival Pigmentation – Videodermoscopy of Conjunctival Melanoma

Author Affiliation(s)

Case Presentation

A 60-year-old man was referred to our clinic with a history of a progressively enlarging pigmented lesion on the conjunctiva of the left eye for over 8 years. The pigmentation was unevenly distributed and affected both the paralimbal and the temporal bulbar conjunctiva ( Figure 1A ). The lesion was completely asymptomatic, and it did not impact the visual capacity. The patient had no significant past medical history and denied any localized trauma or infection. We decided to perform a videodermoscopy of the lesion which findings reveals a predominantly dark brown structureless pattern with a touch of grayish-white veil, peripheral spots, and intralesional vessels exhibiting heteromorphic features ( Figure 1, B and C ).

The lesion was successfully excised by removal of the affected conjunctiva and reconstruction using amniotic membrane flaps, followed by adjuvant therapy with cycles of topical mitomycin. Histological examination confirmed the diagnosis of conjunctival melanoma infiltrating the subepithelial connective tissue with radial extension of intraconjunctival proliferation, 1.45 mm thick (pT1b). The patient visual function was fully preserved.

Teaching Point

Conjunctival melanoma is a rare but extremely life-threatening malignancy neoplasm with associated mortality of up to 30% [ 1 ] . Mandatory is the recognition and evaluation of pigmented conjunctival lesions, especially in patients with a history of progressive growth. Videodermoscopy can aid in identifying characteristic features such as a predominantly structureless pattern, grey-white veil, and polymorphic vessels [ 2 ] .


  1. Conjunctival Melanoma - Epidemiological Trends and Features Kaštelan SS, Gverović Antunica A, Beketić Orešković L, Salopek Rabatić J, Kasun B, Bakija I. Pathol Oncol Res.2018;24(4):787-796. CrossRef PubMed
  2. Dermoscopy for the Diagnosis of Conjunctival Lesions Cinotti E, La Rocca A, Labeille B, et al. Dermatol Clin.2018;36(4):439-449. CrossRef PubMed

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