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Conjunctival melanoma is generally a pigmented lesion that arises from primary acquired melanosis (PAM), from preexisting nevus, or de novo.1 There have been a few reported series of lesions that arise in the lacrimal caruncle, and melanoma in the caruncle is almost always an extension from adjacent PAM. Melanoma confined only to the caruncle without adjacent PAM is rare.2,3 We report a rapidly growing, pedunculated, amelanotic, ulcerated mass arising from the caruncle with no adjacent PAM. Initially, the lesion was suspected to be keratoacanthoma based on the history and clinical course. Histopathology of the excised lesion revealed malignant melanoma, confined to the caruncle, without evidence of PAM.
Shields JA, Pointdujour-Lim R, Lally SE, Eagle RC, Shields CL. Malignant Melanoma Presenting as Pedunculated Lesion of the Caruncle. JAMA Ophthalmol. 2016;134(4):464-466. doi:10.1001/jamaophthalmol.2015.6084