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Bui AQ, Espana EM, Margo CE. Chromoblastomycosis of the Conjunctiva Mimicking Melanoma of the Ciliary Body. Arch Ophthalmol. 2012;130(12):1615–1617. doi:10.1001/archophthalmol.2012.1573
Author Affiliations: Departments of Ophthalmology (Drs Bui, Espana, and Margo) and Pathology and Cell Biology (Drs Espana and Margo), Morsani College of Medicine, University of South Florida, Tampa.
Chromoblastomycosis is a chronic subcutaneous mycosis that typically involves the lower extremities. The vast majority of causative microorganisms have melanized cell walls (ie, are dematiaceous fungi) and belong to 4 genuses of saprophytic fungi: Phialophora, Fonsecaea, Rhinocladiella, and Cladophialophora.1,2 Most human infections can be traced to traumatic implantation. We describe a unique case of conjunctival chromoblastomycosis that mimicked a uveal melanoma with scleral invasion.
A 75-year-old white woman was referred for evaluation of a pigmented lesion of her right nasal conjunctiva. The lesion had been present for 16 years, following a traumatic injury with a tree branch. The initial injury was minor and required no professional medical care. A pigmented lesion, however, developed at the site of injury and enlarged slowly over years. During the last several months, it began causing irritation and redness. When examined, best-corrected visual acuity in the affected eye was 20/25. The lesion was 2.5 mm from the limbus, just thicker than 1 mm, and 3.7 mm in its greatest diameter. Under slitlamp magnification, the surface resembled black cauliflower (Figure 1). The overlying epithelium was shaggy, and it pooled and retained fluorescein (Figure 1, inset). The remainder of findings from the eye examination, including dilated ophthalmoscopy, were unremarkable. Ultrasound biomicroscopy revealed no mass beneath the lesion. Although the history of trauma was reliable, the concern over an invasive melanoma persisted, so a biopsy was recommended with that prevailing clinical diagnosis. Metastatic cutaneous melanoma was possible, although there was no history of skin melanoma. Pigmented squamous cell carcinoma and primary conjunctiva melanoma were less likely because of the location of the mass beneath the epithelium and, in the case of squamous cell carcinoma, the patient's fair complexion.
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