12 conjunctival tumours
TRANSCRIPT
1. Benign• Naevus• Papilloma• Epibulbar dermoid• Lipodermoid
2. Pre-malignant• Primary acquired melanosis ( PAM )• Intraepithelial neoplasia (carcinoma in situ)
3. Malignant• Melanoma• Squamous cell carcinoma• Kaposi sarcoma• Lymphoma
CONJUNCTIVAL TUMOURS
Naevus
• 30% are almost non-pigmented
• Most frequently juxtalimbal• Sharply demarcated and slightly elevated
• Presents in first two decades
PapillomaPedunculated Sessile
• Presents in middle age• Not caused by infection• Single and unilateral
• Presents in childhood or early adulthood• Infection with papilloma virus • May be multiple and bilateral
• Presents in childhood• Smooth, soft mass• Usually juxtalimbal
• Occasionally Goldenhar syndrome
Epibulbar dermoidSigns Association
Lipodermoid
• Presents in adulthood• Soft, movable, subconjunctival mass• Most frequently at outer canthus
Intraepithelial neoplasia(carcinoma in situ)
• Juxtalimbal fleshy avascular mass
• May become vascular and extend onto cornea
• Presents in late adulthood
• Malignant transformation is uncommon
Signs Progression
Primary acquired melanosis (PAM)
• PAM without atypia is benign• PAM with atypia is pre-malignant • Unilateral, irregular areas of flat,
brown pigmentation• May involve any part of conjunctiva
• Presents in late adulthood
Signs Types
Conjunctival melanoma
From PAM with atypia
• Sudden appearance of nodules in PAM
From naevus
• Sudden increase in size or pigmentation
Primary
• Solitary nodule• Frequently juxtalimbal but may be anywhere
• Very rare• Most common type
Localized tumour
• Excision
Treatment of conjunctival melanoma
Diffuse tumour
• Excision of nodules
Orbital recurrence
• Excision and radiotherapy• Adjunctive cryotherapy or
mitomycin C • Exenteration• Adjunctive cryotherapy
Squamous cell carcinoma
• Rarely metastasizes
• Arises from intraepithelial neoplasia or de novo
• Frequently juxtalimbal
• Slow-growing
• Presents in late adulthood• May spread extensively
Signs Progression
Kaposi sarcoma
• Most frequently in inferior fornix
• Affects patients with AIDS• Vascular, slow-growing tumour of low malignancy• Very sensitive to radiotherapy
Lymphoma
• Salmon-coloured, subconjunctival infiltrate
• Usually presents in adulthood• Benign or malignant