CONJUNCTIVAL TUMORS Flashcards
what is conjunctival intraepithelial neoplasia (CIN)?
It is a premalignant condition that does not cross the basement membrane (stay in epithelium)
CIN is a precursor to what __ ocular dz?
squamous cell carcinoma
what is the most common conjunctival malignancy in the US?
squamous cell carcinoma
what are the risk factors for CIN?
- Elderly caucasian males
- UV exposure
- smoking
- HPV
- <50 y/o suspect HIV
symptoms of CIN?
- ocular irritation
- FBS
- dry eye
signs of CIN?
- Gelatinous mass w/ leukoplakia (mainly at limbus).
- Fine vascular patterns w/ a hairpin configuration.
signs of squamous cell carcinoma?
- Fleshy pink papillomatous lesion with feeder vessels.
tx for CIN?
- refer for medical w/u & MRI to r/o orbital invasion.
- excision w/ biopsy
- exenteration + radiation my be needed.
- if recurrent – topical interferon, mitomycin C or 5-fluorouracil can be used.
what is conjunctival nevus?
It is a benign proliferation of melanocytes that presents around puberty or early adulthood (1st-2nd decades).
- It is common for nevi to increase in size & darkness during puberty.
locations for conjunctival nevus?
bulbar conjunctiva at the limbus > caruncle > plica semilunaris
signs for conjunctival nevus? what is diagnostic?
- Unilateral
- Flat (or slightly elevated)
- Solitary
- variable (clearish-dark) pigmentation
- May have cystic spaces – cystic space w/in lesion is dx.
tx for conjunctival nevus?
- monitor with photograph
what is secondary acquired melanosis (SAM)?
- It is excessive melanin production and retention of pigment by epithelial melanocytes that is attributed to racially associated genetic, metabolic, or toxic factor.
- AKA racial melanosis
signs for SAM?
- More common in black people
- Bilateral, asymmetric, seen in the 1st couple of years of life.
- Flat, patchy, brown pigmentation that is scattered throughout the conjunctiva and freely moves w/ palpation.
- Pigmentation more intense near limbus.
tx for SAM?
- no tx needed, monitor.
what is primary acquired melanosis (PAM)?
- It is acquired excessive melanin production
signs of PAM?
- Unilateral
- Elderly (>45 y/o) w/ fair skinned
- Irregular, unifocal or multifocal areas of flat golden brown to dark chocolate-colored patches anywhere in the conjunctiva (even under eyelids).
- Sudden onset of nodules
- 1st sign of malignant transformation - - Increase growth or shrink or become darker or lighter or engorged vascular area.
PAM is a precursor for what malignant Dz?
conjunctival malignant melanoma
what % of PAM cases lead to malignant melanoma?
50-75%
what is malignant melanoma?
are pigmented or non-pigmented malignancy that are secondary to the uncontrolled proliferation of melanocytes
what is the most common site of metastasis for conjunctival malignant melanoma?
- liver – based on KMK
- (parotid or submandibular lymph nodes) – based on NBEO part 2 SG.
signs for conjunctival malignant melanoma?
- Onset >50 y/o.
- Almost exclusively in Caucasians.
- Black or gray highly vascularized nodule that; May be fixed to episcleral or May be located anywhere on conjunctiva.
- May extend onto cornea.
tx for PAM & conjunctival malignant melanoma?
- PAM - monitor carefully with photography for any signs of malignancy
- Malignant Melanoma - excision biopsy, cryotherapy, corneal epitheliectomy, or exenteration.
- if recurrent melanoma – use topical mitomycin C.
- systemic w/u is indicated.
