Thursday, October 13, 2016

Scleral And Conjuctival Pigmentation

A 40-year-old white man came to see his physician about a brown spot in his eye . He noticed this spot many years ago, but after recently reading information on the Internet about brown spots in the eye, became concerned about ocular melanoma. He thinks the spot has changed in size. He denies any eye discomfort or visual changes. He was referred for a biopsy, and the pathology showed a benign nevus that did not require further treatment.


Case Discussion:

Scleral And Conjuctival Pigmentation:

Introduction: Scleral and conjunctival pigmentation is common and usually benign. Nevi can be observed and referred if they change in size. The etiology of scleral or conjunctival nevi is not well understood. Racial melanosis is genetically determined.

Clinical Features: depend on the cause of the pigmentation.
1. Physiologic melanosis is typically bilateral and symmetrical.
2. Primary acquired melanosis (PAM), Nevi, and melanoma are typically unilateral.
3. Intrinsic cysts are common in conjunctival nevi.

Diagnosis: Definitive diagnosis of pigmented ocular lesions is by biopsy.

• Eighty-seven percent of biopsy-proven nevi do not change over time.4
• Features seen more commonly in malignancy: ulceration, hemorrhage, change in color, and formation of new vessels around the lesion.
• Pathologic factors of conjunctival melanoma with a higher mortality rate include increased tumor thickness, location on the palpebral, caruncular or forniceal conjunctiva, increased mitotic activity, lymphocytic invasion, and association with PAM.

Differential Diagnosis:
Pigmented areas on the sclera or conjunctiva include the following:
Benign nevi—Unilateral and stable over time .
Physiologic or racial melanosis—Bilateral and symmetric, most common circumlimbally, and relatively consistent throughout patient’s life
• Primary acquired melanosis (PAM)—Typically unilateral, often multifocal indistinct areas of dark
pigmentation, and can progress to malignancy over time. This term is used clinically when the histology is not known.
Secondary acquired melanosis—Seen with hormonal changes or after trauma to the conjunctiva with irradiation, chemical irritation, or chronic inflammation.
Conjunctival melanoma—Unilateral, nodular, with variegated color and size changes
Alkaptonuria—Rare disease accompanied by dark urine and arthritis.
Nevus of Ota (also known as oculodermal melanocytosis)—Blue-gray scleral pigment involving the periorbital skin as well . It is more common in the Asian population but can be seen in any population. It can also be bilateral. Most importantly these persons should be followed by an ophthalmologist because they are at higher risk for glaucoma and possibly melanoma.

Management: depends on the underlying cause:
• Racial melanosis and nevi are two lesions that can be monitored for changes without a biopsy.
• Refer any changing pigmented lesion in the eye to a specialist who can perform a biopsy.
• Biopsy-proven PAM without atypia does not require excision, but must be monitored for stability.
• Melanosis with atypia is generally removed with large margins because of its potential for conversion into melanoma.
• The primary treatment for conjunctival melanoma is surgical removal. Cryotherapy, radiotherapy, and chemotherapy may be used as adjunct therapy.

2 comments:

  1. Hello, my name is Betty. i was diagnosed of HIV virus 4 years back. Before then, i was dating this Derrick guy. we had something great going on. Our love life only lasted for 8 months. the sixth and seven month of our relationship, i began feeling very weak every now and then. But i never suspected anything until I kept on experiencing different symptoms like having sore throats, constant headache, body weakness e.t.c. I decided to go for a medical check up. I was tested HIV positive. when the doctor broke the news to me, it was as if my whole world had crumbled. it dawned on me then that Derrick has been lying to me. i was very mad to an extent i almost committed suicide. But there was nothing i could do, other than weep and weep. ever since then, i have been spending heavily on medications, going from one medical clinic or the other so I can look healthy. Though since i was a kid, i love herbs a lot. i take herbal tea with grandma while growing so i am quite familiar with herbs. early last year, i was on the internet and on a particular health blog, to check for herbal medication as alternative. I saw many comments and read many testimonies. Until i came across a particular testimony on how Dr.ugo cured a patient from herpes simplex virus using pure natural herbs. i reached out to the doctor because I also was thinking Herpes had no cure. I told him about my HIV status.He encouraged me not to panic that he will help me get my deliverance. he prepared some herbs and sent them to me. The herbs were in four 70ml bottles and I took them morning and night. i used as he directed, and in less than three weeks, i started having appetite to eat plenty of food and i gained back my strength. the fourth week,I consumed all the herbal meds. He encouraged me to go for a test which i did. This time, the result was negative. I quickly contacted the doctor and informed him of the news. I immediately asked him to prepare for Derrick too. He did and sent it. Today, me and Derrick are HIV free. All thanks goes to God Almighty for healing us through Dr.Ugo. if you are having any kind of sickness at all, Dr.Ugo is the right person to talk to and i assure you, you will be glad you did. His email: ugoherbalhome@gmail.com you can also write him on WhatsApp +2348104990619.

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  2. Nice blog
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    I told my Aunt,luckily it was the same Dr,we where referred to few months back by my pastor in church whom members have being testifying about of his cure We did contacted him and explained my problem to him.He prepared the medicine and sent to me with details of how to use and apply. After a while, I began to feel more strong than never before, I felt so lucky and happy when my Doctor congratulated me that he could found no HIV virus again in me. I knew I was free cos my body was so strong. His herbal medicine should have saved my parents life, i said!
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