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July 1981

Cryotherapy for Precancerous Melanosis (Atypical Melanocytic Hyperplasia) of the Conjunctiva

Author Affiliations

From the Departments of Ophthalmology (Drs Brownstein and Jackson), Pathology (Dr Brownstein), and Medicine (Dr Wilkinson), McGill University and the Royal Victoria Hospital, Montreal; the Departments of Ophthalmology (Drs Jakobiec and Lombardo) and Pathology (Dr Jakobiec), the New York Hospital-Cornell University Medical Center, New York; the Manhattan Eye, Ear, and Throat Hospital, New York (Drs Jakobiec and Lombardo); and the Eyebank for Sight Restoration, Inc, New York (Dr Jakobiec).

Arch Ophthalmol. 1981;99(7):1224-1231. doi:10.1001/archopht.1981.03930020098009

• Two patients with progressive, diffuse precancerous melanosis (intraepithelial atypical melanocytic hyperplasia or melanocytic dysplasia) of the conjunctiva were treated with cryotherapy. In one patient, the contiguous cutaneous portions of both eyelids were involved and received the same therapy; the extensive disease of this patient was managed by two cryotherapy sessions during a period of 2½ months. The melanocytic process in both patients showed a good response to this therapy, which resulted in a slough of the superficial conjunctiva with reepithelialization from adjacent areas. Neither patient has shown recurrent disease in more than seven months of follow-up, although one patient had incomplete regression of the melanocytic condition in the perilimbal region, which was subsequently treated by an excisional biopsy. Serious complications occurred in one patient who had corneal and lenticular opacities; this patient had severe extensive disease for which exenteration was considered the only feasible alternative therapy to control the melanocytic proliferative disorder adequately. Less severe complications also developed, including trichiasis, ptosis, transient hypotony, and macular edema. In this article, we discuss the clinical and histologic features of acquired pigmentations of the conjunctiva, the criteria for their management, and the approaches to minimize the complications that we have encountered with cryotherapy.