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April 2016

Malignant Melanoma Presenting as Pedunculated Lesion of the Caruncle

Author Affiliations
  • 1Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
JAMA Ophthalmol. 2016;134(4):464-466. doi:10.1001/jamaophthalmol.2015.6084

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.

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