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A man in his 60s with a history of hypertension, proliferative diabetic retinopathy, and primary open-angle glaucoma presented with 6 months of right-sided bloody tearing. Examination revealed a 7 mm × 5 mm pedunculated mass extending from the conjunctiva of the right superolateral fornix (Figure). The lesion resembled a pyogenic granuloma; however, histopathological analysis was positive for markers characteristic of melanoma—S100 and Melan-A. The conjunctiva overlying the lesion showed no evidence of a precursor lesion such as primary acquired melanosis, so the possibility of metastasis to this site was explored. The patient underwent dermatological examination, whole-body positron emission tomography and computed tomography scans, colonoscopy, and orbital magnetic resonance imaging, from which no other primary mucocutaneous melanoma lesions were found. The patient was scheduled for additional excision with wide margins, cryotherapy for residual disease, and amniotic membrane grafting to prevent scar tissue formation.
Damani MR, O'Brien JM. Amelanotic Conjunctival Melanoma. JAMA Ophthalmol. 2016;134(1):e153568. doi:10.1001/jamaophthalmol.2015.3568