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JAMA Ophthalmology Clinical Challenge
November 2017

A Peaked Pupil

Author Affiliations
  • 1Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida
JAMA Ophthalmol. 2017;135(11):1268-1269. doi:10.1001/jamaophthalmol.2017.2267

A 51-year-old woman presented to our institution’s emergency department with an ocular surface lesion in the left eye. She had an 11-mm pigmented conjunctival lesion that was suspicious for melanoma with significant involvement of the caruncle, bulbar conjunctiva, and palpebral conjunctiva. The patient subsequently underwent a complete excision of the tumor and supplemental cryotherapy to the resection bed. Pathological results confirmed the diagnosis of conjunctival melanoma. The tumor had invaded the medial canthus and medial rectus insertion; however, no scleral invasion was observed during the intraoperative examination. Three months later, she had a new pigment deposition adjacent to the limbus in the area of the prior resection, for which she underwent additional excision and cryotherapy. Pathology specimens from this excision were negative for atypia. The patient was given mitomycin C as adjuvant therapy.

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