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Clinical Sciences
February 2004

Conjunctival Nevi: Clinical Features and Natural Course in 410 Consecutive Patients

Author Affiliations

From the Ocular Oncology Service, Wills Eye Hospital, Thomas JeffersonUniversity, Philadelphia, Pa. The authors have no relevant financial interestin this article.

Arch Ophthalmol. 2004;122(2):167-175. doi:10.1001/archopht.122.2.167
Abstract

Objectives  To describe the clinical features of a conjunctival nevus and to evaluatethe lesion for changes in color and size over time.

Design  Retrospective, observational, noncomparative case series.

Participants  Four hundred ten consecutive patients with conjunctival nevi.

Main Outcome Measures  The 2 main outcome measures were changes in tumor color and size.

Results  Of the 410 patients, 365 (about 89%) were white, 23 (about 6%) wereAfrican American, 8 (2%) were Asian, 8 (2%) were Indian, and 6 (1%) were Hispanic.The iris color was brown in 55% (229/418), blue in 20% (85/418), green in20% (83/418), and not indicated in 5% (21/418). The nevus was brown in 65%,tan in 19%, and completely nonpigmented in 16%. The anatomical location ofthe nevus was the bulbar conjunctiva (302 eyes, 72%), caruncle (61 eyes, 15%),plica semilunaris (44 eyes, 11%), fornix (6 eyes, 1%), tarsus (3 eyes, 1%),and cornea (2 eyes, <1%). The bulbar conjunctival lesions most commonlyabutted the corneoscleral limbus. The nevus quadrant was temporal (190 eyes,46%), nasal (184 eyes, 44%), superior (23 eyes, 6%), and inferior (21 eyes,5%). Additional features included intralesional cysts (65%), feeder vessels(33%), and visible intrinsic vessels (38%). Cysts were clinically detectedin 70% of histopathologically confirmed compound nevi, 58% of the subepithelialnevi, 40% of the junctional nevi, and 0% of the blue nevi. Of the 149 patientswho returned for periodic observation for a mean of 11 years, the lesion colorgradually became darker in 5% (7 patients), lighter in 8% (12 patients), andwas stable in 87% (130 patients). The lesion size was larger in 7% (10 patients),appeared smaller in 1% (1 patient), and was stable in 92% (137 patients).There were 3 patients who developed malignant melanoma from a preexistingcompound nevus (2 cases) or blue nevus (1 case) over a mean interval of 7years.

Conclusions  Conjunctival nevus is a benign tumor most often located at the nasalor temporal limbus and rarely in the fornix, tarsus, or cornea. Over time,a change in tumor color was detected in 13% (20/149) and a change in tumorsize was detected in 8% (12/149).

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