PMC5015600_01
Clinical appearance of the lesion at first visit (LE)
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F1
The patient presented a visual acuity of 10/10 in both eyes and the anterior segment showed on RE nasal pterygia grade II; on the left eye (LE) evidenced a pigmented lesion on the bulbar conjunctiva between the caruncle and the sclero-corneal limbus, slightly elevated with mild vascular tone and very pigmented, with a well-defined and fusiform appearance in the vertical and linear, sessile, which moved freely over the sclera (Figure 1 (Fig. 1)).
Clinical appearance of the temporal lesion at bulbar conjunctiva (LE)
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F2
The same eye recognizes a pigmented lesion in the upper bulbar conjunctiva extending to the limbus esclerocornea located in the temporal area without accompanying nodules or abnormal vascularization (Figure 2 (Fig. 2), Figure 3 (Fig. 3)).
Clinical appearance of the temporal lesion at bulbar conjunctiva (LE)
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F3
The same eye recognizes a pigmented lesion in the upper bulbar conjunctiva extending to the limbus esclerocornea located in the temporal area without accompanying nodules or abnormal vascularization (Figure 2 (Fig. 2), Figure 3 (Fig. 3)).
Fragment of lesion where it's possible to recognize pigmented tumoral mass (A). Higher magnification of the image preceding: the superficial layers of the epithelium of the conjunctiva are infiltrated by atypical melanocytes (B).
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F4
The excisional biopsy shows a neoplasic lesion composed of atypical cells with large vesicular nuclei and prominent eosinophilic nucleoli; the cytoplasm is clear or containing melanin; the neoplastic cells invaded superficial layers of the epithelium of the conjunctiva and, immunohistochemically, were reactive for Melan A and HMB-45, indicating cells of melanocytic origin. These features establishes the diagnosis of conjunctival melanoma (Figure 4 (Fig. 4), Figure 5 (Fig. 5)).
Immunohistochemical staining revealing that neoplastic cells were positive for melan A (A) and HMB-45 (B), indicating cells of melanocytic origin.
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F5
The excisional biopsy shows a neoplasic lesion composed of atypical cells with large vesicular nuclei and prominent eosinophilic nucleoli; the cytoplasm is clear or containing melanin; the neoplastic cells invaded superficial layers of the epithelium of the conjunctiva and, immunohistochemically, were reactive for Melan A and HMB-45, indicating cells of melanocytic origin. These features establishes the diagnosis of conjunctival melanoma (Figure 4 (Fig. 4), Figure 5 (Fig. 5)).