Oftalmologia EG__04 Oncologia__05 Conjunctiva Flashcards
1
Q
What are the 3 topographic regions of the conjunctiva?
A
Palpebral, Forniceal, Bulbar
2
Q
The type of epithelium lines the conjunctiva?
A
nonkeratinized stratified squamous
3
Q
What type of epithelium is shown below?
A
Nonkeratinized stratified squamous
4
Q
The stroma of the conjunctiva is also known as the?
A
substantia propria
5
Q
In the substantia propria of the conjunctiva there are lymphocytes organized in follicles known as?
A
conjunctiva-associated lymphoid tissue (CALT)
6
Q
What is the only part of the conjunctiva stroma that contains sebaceous glands and hair follicles?
A
Caruncle
7
Q
What portion of the conjunctiva is shown below?
A
Caruncle - has sebaceous glands (S) and hair follicles (H)
8
Q
One congenital anomaly of the conjunctiva is a?
A
dermoid which is a firm, dome-shaped white-yellow nodule that is typically found near the limbus.
9
Q
What type of congenital conjunctival anomaly is shown below?
A
Dermoid
10
Q
What 2 syndromes are limbal dermoids of the conjunctiva associated with?
A
Goldenhar syndrome, Linear nevus sebaceous syndrome
11
Q
What are the arrows pointed at in this image of a dermoid?
A
Hair follicle
12
Q
What are the S labels at in this image of a dermoid?
A
Sebaceous gland
13
Q
What are the H labels at in this image of a dermolipoma?
A
Hair follicles
14
Q
What are the A labels at in this image of a dermoid?
A
Adipose tissue
15
Q
What are the O labels at in this image of a complex choristoma?
A
Osseous choristoma
16
Q
What are the L labels at in this image of a complex choristoma?
A
Lipodermoid choristoma
17
Q
What is the most common quadrant to find conjunctival dermoids?
A
inferotemporal
18
Q
What is the most common quadrant to find conjunctival lipodermoids/dermolipomas?
A
Superotemporal
Typically closer to the fornix
19
Q
What are the most common hamartomas of the conjunctiva?
A
Capillary hemangiomas
20
Q
How can conjunctival inflammation be categorized based on timing?
A
acute, chronic
21
Q
How can conjunctival inflammation be categorized based on type of inflammation?
A
papillary, follicular, granulomatous
22
Q
How can conjunctival inflammation be categorized based on etiology of inflammation?
A
infectious, noninfectious
23
Q
What are the two categories of conjunctival inflammation based on etiology?
A
Infectious or noninfectious.
24
Q
What is the characteristic of papillary conjunctival inflammation?
A
Papillary - checkered blue conjunctiva covers fibrovascular core of blood vessels (red) with stroma eosinophils (pink) and plasma cells (light blue).
25
What is the characteristic of follicular conjunctival inflammation?
Follicular - checkered blue epithelium covers lymphoid follicles (center light blue) that is surrounded by a dark corona (purple).
26
What is the appearance of papillary conjunctival inflammation?
Papillary - cobblestone pattern.
27
What is the appearance of closely packed papillae in papillary conjunctival inflammation?
Papillary - closely packed, flat-topped papillae with central fibrovascular cores (arrows).
28
What is the appearance of follicular conjunctival inflammation?
Follicular - pale, dome-shaped nodules without a prominent central vessel.
29
What is the characteristic of follicular inflammation regarding lymphoid follicles?
Follicular - lymphoid follicle with the boundary between the germinal center and mantle (arrowheads).
30
What is the name of granulomatous conjunctivitis associated with preauricular lymphadenopathy?
Parinaud oculoglandular syndrome.
31
What organisms are associated with Parinaud oculoglandular syndrome?
Bartonella henselae, Francisella tularensis, Mycobacteria, Syphilis, Fungi.
32
What organisms are associated with Parinaud oculoglandular syndrome?
Bartonella henselae, Francisella tularensis, Mycobacteria, Syphilis, Fungi
33
What is the most common noninfectious cause of granulomatous conjunctivitis?
Sarcoidosis
34
What type of conjunctival inflammation is shown below?
Granulomatous
35
What type of conjunctival inflammation is shown below?
Granulomatous - arrowhead pointing at a multinucleated giant cell
36
What type of finding in a conjunctival granuloma is shown below?
Foreign fibers under polarized light (arrows)
37
What type of finding in a conjunctival granuloma is shown below?
Foreign fibers with granulomatous inflammation, arrowhead pointing at a multinucleated giant cell
38
What is the purpose of viewing conjunctival granulomas under polarized light?
ID offending foreign material
39
What finding is demonstrated by the asterisk in this patient with chlamydia?
Cytoplasmic inclusion body
40
What is the next step in the workup of a patient with suspected conjunctival mucous membrane pemphigoid (MMP)?
Conjunctival biopsy
41
What immune cell is enriched in conjunctival biopsies of MMP?
plasma cells
42
What type of staining is the gold standard for the diagnosis of MMP?
Immunofluorescence for Igs
43
What will immunofluorescent staining for immunoglobulins and complement in MMP demonstrate?
linear deposition at the epithelial basement membrane
44
What cause of autoimmune conjunctival inflammation is shown below?
MMP - conj infection, symblepharon formation, shortening of the inferior fornix
45
What type of autoimmune conjunctival inflammation is shown below?
MMP - linear band of immunofluorescence
46
What is demonstrated by the arrows in the path slide below of MMP?
Epithelial bullae
47
What is the sensitivity of immunofluorescence staining for MMP?
As low as 50%
48
What are pyogenic granulomas?
Pyogenic granulomas are misnomer because the lesion is neither pus-producing nor a true granuloma.
49
What is the primary tissue composition of a pyogenic granuloma?
Granulation tissue with inflammatory cells
50
What is the classic histologic pattern of the blood vessels of pyogenic granulomas?
Spoke-wheel pattern of vascular growth
51
What type of conjunctival lesion is shown below?
Pyogenic granuloma - spoke wheel vascular pattern
52
What type of conjunctival lesion is shown below?
Pyogenic granuloma
53
What is a pinguecula?
A pinguecula is a small, yellowish conjunctival lesion that is typically located at the nasal or temporal limbus.
54
What type of conjunctival lesion is shown below?
Pinguecula
55
What are pingueculas typically a manifestation of?
Pingueculas are typically a manifestation of actinic (sunlight exposure) damage.
56
What is observed on histologic examination of pinguecula/pterygium?
On histologic examination of pinguecula/pterygium shows fragmentation of collagen with basophilic degeneration. This is also known as elastotic degeneration.
57
What is demonstrated by the asterisk in the histologic slide of a pinguecula below?
Acellular amorphous slightly basophilic material in the stroma
58
What is demonstrated by the arrows in the histologic slide of a pinguecula below?
Elastotic degeneration
59
What is demonstrated by the asterisk in the histologic slide of a pinguecula below?
Basophilic material that stains black with elastin stain
60
What is indicated by the asterisk in the histologic slide of a pinguecula?
Basophilic material that stains black with elastin stain
61
What is the major difference between pterygium and pinguecula?
The major difference is the invasion of the superficial cornea with a growth.
62
What type of corneal degeneration is shown below?
Pterygium
63
What is the typically the main difference between pterygium and pinguecula on histology?
Prominent blood vessels
## Footnote
Both have elastotic degeneration.
64
What does the term 'recurrent pterygia' refer to?
Pterygium where there is complete lack of elastotic degeneration on histology.
65
What is demonstrated by the arrow in this histologic slide of pterygium?
Elastotic degeneration
66
What is demonstrated by the arrowheads in this histologic slide of pterygium?
Prominent blood vessels
67
Is there potential for malignant transformation in patients with pingueculas or pterygia?
Yes - though much lower than other types of actinic skin lesions
68
What is the most common type of amyloid deposited in amyloidosis of the conjunctiva?
AL amyloid - from immunoglobulin
69
What is the primary source of amyloid deposited in amyloidosis of the conjunctiva?
Local clonal plasma cells
70
What causes secondary amyloidosis of the conjunctiva?
Deposition of AA amyloid, typically from long-standing inflammation such as trachoma.
71
What is secondary amyloidosis of the conjunctiva due to?
It is due to deposition of AA amyloid, typically from long-standing inflammation such as trachoma.
72
What type of conjunctival degeneration is shown below?
Amyloidosis.
73
How does amyloidosis of the conjunctiva appear histologically on H&E?
It appears as eosinophilic extracellular deposits.
74
What color does amyloid appear under congo red stain?
Red-orange.
75
How does amyloid appear under congo red stain with polarized light?
It appears birefringent (orange and apple-green).
76
What type of conjunctival degeneration is shown below?
Epithelial inclusion cyst.
77
What type of conjunctival degeneration is shown below?
Epithelial inclusion cyst - cyst lined by nonkeratinized stratified squamous epithelium.
78
What type of conjunctival neoplastic growth is shown below?
Pedunculated papilloma - exophytic, pink-red, strawberry-like.
79
What are the most common locations of pedunculated papillomas of the conjunctiva?
Caruncle, Plica semilunaris, Forniceal conjunctiva.
80
What infection is associated with pedunculated papillomas of the conjunctiva?
HPV subtypes 6 and 11.
81
What does histologic examination of a pedunculated papilloma demonstrate?
It demonstrates a papillary fibrovascular core covered by hyperplastic squamous epithelium.
82
What is the histologic examination of a pedunculated papilloma?
A papillary fibrovascular core covered by hyperplastic squamous epithelium.
83
What type of conjunctival neoplastic lesion is shown below?
Pedunculated papilloma.
84
Which of pedunculated or sessile conjunctival papillomas are more likely to transform into a malignancy?
Sessile.
85
What infection is associated with sessile papillomas of the conjunctiva?
HPV subtypes 16 and 18.
86
What is the common location for sessile papillomas of the conjunctiva?
Bulbar conj - esp near the limbus.
87
What type of conjunctival papilloma is more likely to occur in children?
Pedunculated.
88
What type of conjunctival papilloma is more likely to occur in adults?
Sessile.
89
What clinical features of a sessile papilloma are worrisome for malignant transformation?
Leukoplakia and Inflammation.
90
What histologic features of a sessile papilloma are suggestive of ocular surface squamous neoplasia?
Nuclear hyperchromasia and pleomorphism.
91
What histologic features of a sessile papilloma are suggestive of ocular surface squamous neoplasia?
Nuclear hyperchromasia and pleomorphism, altered cell polarity, and abundant mitotic figures.
92
What is ocular surface squamous neoplasia (OSSN)?
OSSN is a wide spectrum of dysplastic changes including conjunctival intraepithelial neoplasia (CIN) and squamous cell carcinoma (SCC).
93
OSSN typically arises in what part of the conjunctiva?
Interpalpebral limbal area.
94
OSSN typically occurs more commonly in patients that live around what region of the world?
Equatorial region.
95
Why is OSSN more common in the equatorial regions of the world?
UV-light exposure.
96
What mutation in OSSN is associated with UV light?
p53.
97
What type of hereditary condition is a risk factor for OSSN?
Deficiency of DNA repair (xeroderma pigmentosum).
98
What types of infections are associated with OSSN?
HPV (16 and 18) and HIV.
99
What age is a risk factor for OSSN?
Older age.
100
What social habit is a risk factor for OSSN?
Smoking.
101
What is the major clinical appearance of OSSN?
The major clinical appearance of OSSN is epithelial thickening. This may be associated with a prominent corkscrew vascular pattern.
102
What is observed on histologic examination of OSSN?
On histologic examination of OSSN, there is hyperplasia of the epithelium.
103
What histologic change is observed in OSSN?
There is loss of globlet cells as well as loss of cell polarity.
104
What is the histologic change associated with leukoplakia in OSSN?
Surface keratinization.
105
What is demonstrated by the arrow in the histologic image of OSSN?
Demarcation between normal and abnormal epithelium.
106
What is demonstrated by the M in the histologic image of OSSN?
Mitotic figures.
107
What is demonstrated by the arrowheads in the histologic image of OSSN?
Basement membrane.
108
What is demonstrated by the arrows in the histologic image of SSC?
Squamous epithelium violating the basement membrane and invading the stroma.
109
What is the most important assessment to be made histologically in OSSN?
If the neoplasia is contained to the basement membrane.
110
What term is used when neoplasia is contained by the basement membrane in OSSN?
Conjunctival intraepithelial neoplasia (CIN).
111
What term is used when neoplasia has gone through the basement membrane in OSSN?
Squamous cell carcinoma (SCC).
112
How is CIN graded as mild, moderate, or severe?
Degree of cellular atypia.
113
How is CIN graded?
CIN is graded as mild, moderate, or severe based on the degree of cellular atypia.
114
What is a risk factor for intraocular spread of SCC of the conjunctiva?
A risk factor for intraocular spread of SCC of the conjunctiva is a previous ocular surgical procedure.
115
What is another risk factor for intraocular spread of SCC of the conjunctiva?
A risk factor for intraocular spread of SCC of the conjunctiva is immunosuppression.
116
What are the two rare variants of conjunctival carcinoma that spread very aggressively?
The two rare variants of conjunctival carcinoma that spread very aggressively are Mucoepidermoid carcinoma and Spindle cell carcinoma.
117
What is a type of ocular surface melanocytic lesion that is typically present during childhood?
A type of ocular surface melanocytic lesion is a conjunctival nevus, which appears as a small pigmented lesion located on the conjunctiva.
118
What is a type of ocular surface melanocytic lesion that is typically present at birth?
A type of ocular surface melanocytic lesion is ocular melanocytosis, which appears as a diffuse blue-gray lesion located on the episclera.
119
What is a type of ocular surface melanocytic lesion that is typically present during young adulthood?
A type of ocular surface melanocytic lesion is complexion-associated melanosis, which appears as bilateral flat pigmented lesions located on the conjunctiva.
120
What is a type of ocular surface melanocytic lesion that is typically present during infancy?
A type of ocular surface melanocytic lesion is primary acquired melanosis, which appears as a flat pigmented lesion on the conjunctiva.
121
What is a type of ocular surface melanocytic lesion?
Primary acquired melanosis
## Footnote
Typically present during middle age and appears as diffuse unilateral pigmented lesions located on the conjunctiva.
122
What other type of lesion is associated with conjunctival melanocytic nevi?
Epithelial inclusion cysts
123
What changes occur to melanocytic nevi of the conjunctiva during puberty?
Increased size and pigmentation
124
What part of the conjunctiva are melanocytic nevi typically found?
Bulbar
## Footnote
Rarely on the palpebral conjunctiva.
125
What is demonstrated by the arrow in the histological image of a melanocytic nevus?
Epithelial-stromal junction
126
What is demonstrated by the arrowheads in the histological image of a melanocytic nevus?
Melanocyte nests
127
What is demonstrated by the asterisks in the histological image of a melanocytic nevus?
Epithelial inclusion cysts
128
How are conjunctival melanocytic nevi categorized when residing at the epithelial-stromal junction?
Junctional
129
How are conjunctival melanocytic nevi categorized when residing exclusively in the stroma?
Subepithelial or stromal
130
What are conjunctival melanocytic nevus categorized as when residing in the junction and stroma?
Conjunctival melanocytic nevus are categorized as compound.
131
Do epithelial cysts within a conjunctival melanocytic nevus indicate that it is benign or malignant?
Epithelial cysts within a conjunctival melanocytic nevus indicate that it is benign.
132
In a blue conjunctival nevus, where are the melanocytes located?
In a blue conjunctival nevus, the melanocytes are located in the deep stroma.
133
What is the morphology of melanocytes in a blue conjunctival nevus?
The morphology of melanocytes in a blue conjunctival nevus is spindly.
134
In ocular melanocytosis, where is the nevus located?
In ocular melanocytosis, the nevus is located in the deep episceral and sclera.
135
What color appearance results from a nevus in ocular melanocytosis?
The appearance is slate-gray.
136
What is another name for oculodermal melanocytosis?
Oculodermal melanocytosis is also known as nevus of Ota.
137
Where does malignant transformation of a melanocytic lesion typically occur?
Malignant transformation of a melanocytic lesion typically occurs at the uveal tract.
## Footnote
Rare for cutaneous, orbital and meningeal lesions.
138
What mutations are associated with nevi of Ota?
Mutations associated with nevi of Ota include GNAQ and GNA11.
139
What type of pigmented lesion is shown below?
The type of pigmented lesion shown is conjunctival melanocytic nevus.
140
What type of pigmented lesion is shown below?
Ocular melanocytosis
141
What is demonstrated by the E in the histologic image of ocular melanocytosis below?
Episclera
142
What is demonstrated by the S in the histologic image of ocular melanocytosis below?
Sclera
143
What is demonstrated by the U in the histologic image of ocular melanocytosis below?
Uveal tract
144
What is the difference between a nevus and a melanosis?
Nevus is a nest of hyperplastic melanocytes, melanosis is a diffuse spread of melanosomes
145
What are the 3 types of conjunctival melanosis?
Primary acquired melanosis, Secondary acquired melanosis, Complexion-associated melanosis
146
What are the 2 major types of secondary acquired melanosis of the conjunctiva?
Systemic disease - ie addisons, Conjunctival lesion associated - ie carcinoma
147
What is the major subdivision of primary acquired melanosis (PAM)?
With atypia, Without atypia
148
What type of patient population is associated with complexion-associated melanosis?
Patients with dark skin pigmentation
149
What type of pigmented lesion is shown below?
Complexion-associated melanosis
150
Patients with complexion-associated melanosis may have streaks and whorls of melanotic pigmentation that extends into the peripheral cornea which is called?
striate melanokeratosis
151
What is striate melanokeratosis?
Striate melanokeratosis is also known as nea.
152
What happens to the number of melanocytes in complexion-associated melanosis?
Normal
153
What happens to the cytomorphology of melanocytes in complexion-associated melanosis?
Normal
154
Which type of pigmented conjunctival lesions have no significant association with melanoma?
Complexion associated melanosis
Secondary acquired melanosis
155
What locations of PAM are associated with a worse prognosis of possible malignant transformation?
Caruncle
Fornix
Palpebral conjuntiva
156
What is predictive of prognosis/malignant transformation in patients with PAM?
The number of clock-hours of conjunctival involvement.
157
What type of pigmented lesion is shown below?
PAM - only 1 clock hour
158
What type of pigmented lesion is shown below?
PAM - 12 clock hours
159
What is the degree of cellular atypia in the histologic image of PAM below?
None
160
In PAM, is nest formation considered atypia?
Yes
161
In PAM with atypia, what is migration to the superficial epithelium known as?
Pagetoid spread.
162
What type of cellular morphology is demonstrated by the arrows in the image below of PAM with atypia?
Epithelioid
163
What 2 histologic features of PAM with atypia classify it as moderate to severe atypia?
Epithelioid
164
What 2 histologic features of PAM with atypia classify it as moderate to severe atypia?
Epithelioid cytomorphology and/or Pagetoid spread
165
What 2 histologic features of PAM with atypia classify it as conjunctival melanoma in situ?
75% of epithelium with epithelioid melanocytes and/or Pagetoid spread
166
What % of conjunctival melanoma arise from PAM with atypia?
50-70%
## Footnote
Rest are nevus or de novo
167
What location of conjunctival melanoma is associated with worse prognosis?
Nonbulbar location
## Footnote
ie plica semilunaris, caruncle, foniceal or palpebral
168
What histologic feature of conjunctival melanoma is associated with worse prognosis?
Greater thickness
169
What type of conjunctival pigmented lesion is shown below?
Conjunctival melanoma
170
What is demonstrated by the asterisk in the image below of conjunctival melanoma?
Melanoma
171
What is demonstrated by the arrows in the image below of conjunctival melanoma?
PAM with atypia
172
What type of conjunctival pigmented lesion is shown below?
Anterior uveal melanoma
173
What source of the melanoma should be considered when there is a pigmented episcleral nodule that is associated with sentinel vessels without surrounding PAM?
Uveal
174
What are the 2 subdivisions of the corona of the lymphoid follicle?
Marginal zone and Mantle zone
175
What is the gross appearance of lymphoproliferative conjunctival lesions?
Soft mobile salmon-pink masses
176
What type of conjunctival lesion is shown below?
Lymphoproliferative lesion
177
Is the following lymphoproliferative lesion benign or malignant?
Benign - good organization of the germinal center and corona
178
Is the following lymphoproliferative lesion benign or malignant?
Malignant - sheets of cells infiltrating the stroma without well-defined follicles
179
Is the following lymphoproliferative lesion benign or malignant?
Malignant - sheets of cells without well-defined follicles
180
What is the typical prognosis of conjunctival lymphomas?
Relatively good
181
What mass is a benign proliferation of apocrine or accessory lacrimal gland epithelium?
Oncocytoma
182
What is the typical population associated with oncocytomas?
Elderly women
183
What is the typical gross appearance of oncocytomas?
Tan to reddish vascularized nodules
184
What type of conjunctival proliferation is shown below?
Oncocytoma
185
What is the appearance of the cytoplasm in oncocytomas?
Eosinophilic due to numerous mitochondria
186
What is being demonstrated by the arrows in the histologic image of oncocytoma below?
Eosinophilic protein filled lumen
187
Conjunctival melanocytic nevus are categorized as what when they are residing exclusively in the stroma?
Subepithelial or stromal
188
Conjunctival melanocytic nevus are categorized as what when they are residing in the junction and stroma?
Compound
189
What feature of the normal conjunctiva is being highlighted by the arrow below?
Blood vessel
190
What feature of normal conjunctiva is being highlighted by the arrow below?
Pseudoglands of Henle - infolding of conj epithelium with abundant goblet cells
191
What feature of the normal conjunctiva is being highlighted by the arrow below?
Mucin in a goblet cell (PAS stain)
192
What is the difference between a complex choristoma and dermoid?
Contains other tissue such as bone, cartilage or neural tissue
193
What disorder is associated with complex choristomas?
Linear nevus sebaceous syndrome
194
What % of patients with MMP have skin involvement?
25%
195
Patient with MMP can have immunofluorescence with linear deposition of what substances along the basement membrane?
Immunoglobulins, C3
196
In patients with conjunctival biopsies for infectious granulomatous conjunctivitis, are the lesions typically caseating or noncaseating?
Caseating
197
Are the lesions for infectious granulomatous conjunctivitis typically caseating or noncaseating?
Caseating
198
What is being highlighted by the N and L in the following image of a pyogenic granuloma?
Both neutrophils and lymphocytes (acute and chronic inflammatory cells) present
199
What does the term elastotic degeneration mean?
Stains with elastin even after tissue has been treated with elastase to digest true elastin
200
What is the more correct classification of a recurrent pterygium?
Pannus OR Fibrovascular connective tissue response
201
What is being demonstrated by the asterisk in the following image of a pterygium below?
Prominent blood vessels
202
What is being demonstrated by the arrowheads in the following image of a pterygium below?
Destruction of Bowman's layer by the ingrowth of fibroconnective tissue
203
Are goblet cells present in papillomas?
Yes!
204
A systemic infection should be suspected in any patient with OSSN younger than age 50.
HIV
205
What type of conjunctival lesion is seen below?
OSSN - superior limbal gelatinous lesion that extends onto the cornea; AS-OCT demonstrates epithelial thickening
206
What type of conjunctival lesion is seen below?
OSSN - temporal limbal gelatinous lesion that extends onto the cornea; AS-OCT demonstrates epithelial thickening and prominent subepithelial hyperreflectivity
207
What type of OSSN is seen below?
CIN - no invasion of the basement membrane
208
What type of OSSN is seen below?
SCC - superficial invasion
209
What are the 2 major risk factors for intraocular invasion of the scleral or cornea in invasive conjunctival SCC?
1. Previous surgical procedure
2. Immunosuppressed
210
Does the normal nonpigmented conjunctiva contain melanocytes?
Yes! Just so lightly pigmented you cannot tell without histology
211
What is an inflamed juvenile conjunctival nevus?
An inflamed juvenile conjunctival nevus is a compound nevus that appears to grow rapidly. But on histology, the nevus cells are surrounded by chronic inflammatory cells (lymphocytes, plasma cells and eosinophils) and is not malignant.
212
What is intraepithelial nonproliferative melanocytic pigmentation?
Intraepithelial nonproliferative melanocytic pigmentation is a condition in which a small number of conjunctival melanocytes synthesize an increased amount of melanin that is transferred to surrounding basal epithelial cells.
213
What is intraepithelial melanocytic proliferation without atypia?
Intraepithelial melanocytic proliferation without atypia is a condition in which increased numbers of normal appearing dendritic melanocytes undergo hyperplasia.
214
Which forms of melanosis generally do not involve melanocytic proliferation, but rather increased pigment production?
1. Secondary
2. Complexion-associated
215
What type of melanosis is seen below?
Complexion associated (or secondary)
216
What type of melanosis is seen below?
PAM without atypia
217
What type of melanosis is seen below?
PAM with moderate to severe (right of arrows) atypia
218
What type of melanosis is seen below?
Melanoma in situ
219
What is the alternative name for PAM with atypia?
conjunctival melanocytic intraepithelial neoplasia (C-MIN)
220
What IHC stains are used to visualize PAM with atypia?
Melan A
HMB-45
MITF
221
What are the clinical features associated with worse prognosis of conjunctival melanoma?
Nonbulbar location
Tumor thickness > 1.8 mm
Involvement of the eyelid margin
222
What % of conjunctival melanomas have mutations in the BRAF gene?
30-50%
## Footnote
Increased risk of metastasis
223
What % of conjunctival lymphomas are localized to the conjunctiva?
70-75%
