Growths And Pigments Flashcards
Difference between CIN and pinguecula
CIN has neovascularization
Most common conjunctival malignancy in the US
CIN
What is CIN
Unilateral, pre-malignant condition that can progress to a SCC (although the risk is low). Risk factors for development of CIN include UV-B exposure, fair skin, xeroderma pigmentosa, exposure to petroleum derivatives, HIV, and HPV
Appx 95% of cases are located on the limbus with inthe interpalpebral fissure, although it can progress onto the cornea. Although the presentation can vary, CIN commonly appears as an elevated gelatinous mass with neovascularization; 10% of cases exhibit leukoplakia (keratinization)
What is conjunctival SCC
Rare and slow growing malignant tumor that are most common in elderly caucasian (90%) males (81%); it is associated with UV radiation and is most commonly derived from CIN. It is usually located at the limbus., contains a feeder vessel, and involves the cornea.
Limbus
Feeder vessels
Neo
What is racial melanosis
Characterized by benign (no malignant potential), flat, patchy areas of conjunctival pigmentation that are most concentrated at the limbus. It is typically bilateral and asymmetric, and is most common in AA
Difference between PAM and racial melanosis
PAM
- unilateral
- caucasian
Racial melanosis
- bialteral
- AA
What is PAM
Rare, unilateral, acquired conjunctival pigmentation that us most common in elderly caucasians; it has pre-malignant potential and 30% of cases progress to malignant conjunctival melanoma. PAM results from the proliferation of intraepithelial melanocytes
- located anywhere on the conjunctiva and appears as flat patches of pigmentation with indistinct margins.
- nodular lesions with increased vascularity and/or increased growth are most suspect for potential malignancy. A biopsy is warranted to determine whether the lesion is malignant
What is a conjunctival nevus
Rare, benign proliferation of melanocytes that presents around puberty and early adulthood (within the first 2 decades of life); typically unilateral, flat, or slightly elevated, freely mobile, and occasionally non pigmented (30%). It is not uncommon for the size and the darkness of the nevus to increase during puberty
Most common location for conjunctival nevus
Juxtalimbal conjunctiva, followed by the plica and the caruncle. If a pigmented lesion is on the palpebral conjunctival, consider it PAM
If a pigmented lesion is found on the palpebral conj, considered it
PAM
What is diagnostic for conjunctival nevus
Inclusion cysts
If a conjunctival nevus is located in a weird location
Cornea, fornices, etc
Biopsy
Conjunctival lymphomas
Smooth ,fleshy, sub-conjunctival, salmon colored patches that typically occur in middle age adults. Prognosis caries depending on whether the lesion is benign (reactive lymphoid hyperplasia) of malignant (non Hodgkin’s lymphoma, mucosa associated lymphoid tissue (MALT))
Pyogenic granuloma
Pedunculated, benign, fleshy, vascualr lesions of the palpebral conjucntiva that typically result from trauma (often vary minor), surgery, a chalazion, or other sources of chronic irritation. Typically grow very rapidly over a period of a few weeks to an average size of a half an inch
Malignant melanomas of the conjunctiva
Secondary to uncontrolled proliferation of melanocytes
Almost exclusively in caucasians and typically develop around age 50
Pigmented or non pigmented
Most commonly arise from PAM (PAM, then nevus, then de novo, in order of most common to least common)
