CONJUNCTIVAL TUMORS

Question 1

what is conjunctival intraepithelial neoplasia (CIN)?

Answer 1

It is a premalignant condition that does not cross the basement membrane (stay in epithelium)

Question 2

CIN is a precursor to what __ ocular dz?

Answer 2

squamous cell carcinoma

Question 3

what is the most common conjunctival malignancy in the US?

Answer 3

squamous cell carcinoma

Question 4

what are the risk factors for CIN?

Answer 4

• Elderly caucasian males
• UV exposure
• smoking
• HPV
• <50 y/o suspect HIV

Question 5

symptoms of CIN?

Answer 5

• ocular irritation
• FBS
• dry eye

Question 6

signs of CIN?

Answer 6

• Gelatinous mass w/ leukoplakia (mainly at limbus).
• Fine vascular patterns w/ a hairpin configuration.

Question 7

signs of squamous cell carcinoma?

Answer 7

• Fleshy pink papillomatous lesion with feeder vessels.

Question 8

tx for CIN?

Answer 8

• 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.

Question 9

what is conjunctival nevus?

Answer 9

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.

Question 10

locations for conjunctival nevus?

Answer 10

bulbar conjunctiva at the limbus > caruncle > plica semilunaris

Question 11

signs for conjunctival nevus? what is diagnostic?

Answer 11

• Unilateral
• Flat (or slightly elevated)
• Solitary
• variable (clearish-dark) pigmentation
• May have cystic spaces – cystic space w/in lesion is dx.

Question 12

tx for conjunctival nevus?

Answer 12

• monitor with photograph

Question 13

what is secondary acquired melanosis (SAM)?

Answer 13

• 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

Question 14

signs for SAM?

Answer 14

• 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.

Question 15

tx for SAM?

Answer 15

• no tx needed, monitor.

Question 16

what is primary acquired melanosis (PAM)?

Answer 16

• It is acquired excessive melanin production

Question 17

signs of PAM?

Answer 17

• 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.

Question 18

PAM is a precursor for what malignant Dz?

Answer 18

conjunctival malignant melanoma

Question 19

what % of PAM cases lead to malignant melanoma?

Answer 19

50-75%

Question 20

what is malignant melanoma?

Answer 20

are pigmented or non-pigmented malignancy that are secondary to the uncontrolled proliferation of melanocytes

Question 21

what is the most common site of metastasis for conjunctival malignant melanoma?

Answer 21

• liver – based on KMK
• (parotid or submandibular lymph nodes) – based on NBEO part 2 SG.

Question 22

signs for conjunctival malignant melanoma?

Answer 22

• 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.

Question 23

tx for PAM & conjunctival malignant melanoma?

Answer 23

• 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.