Conjunctival Melanoma in Children: A Clinicopathologic Study of 2 Cases

Report of Cases. Case 1. A 9-yearold white girl underwent excision of a small, rapidly growing, black pigmented lesion of the inferior palpebral conjunctiva and the adjacent margin of the right lower eyelid. The original histopathologic diagnosis was an active junctional nevus of the conjunctiva and eyelid margin. The lesion recurred 3 years later and was excised by a dermatologist who did not send the specimen for histopathologic examination. Two years later, the pigmented lesion again recurred and was treated by a largewedge eyelid resection, with an initial histopathologic diagnosis of active compound nevus. One year later, the pigmented lesion recurred in the same location, progressively enlarged to 9 mm in width, had a nodular appearance, and extended to the inferior fornix (Figure 1). The histopathologic diagnosis of the excised tumor was melanoma. After 12 years of followup, there was no evidence of recurrence or metastatic disease. Histopathologic findings of the first specimen (taken at age 9 years) showed a small fragment of mucocutaneous tissue with some clusters of melanin-containing cells in the junctional region and with pagetoid invasion of the epithelium by epithelioid cells with involvement of 1 lateral margin (Figure 2). The diagnosis was revised from active junctional nevus to in situ melanoma of the conjunctiva and eyelid margin. The second specimen (obtained at age 14 years) disclosed a melanocytic tumor containing some melanin pigment in the junctional region with pagetoid invasion into the overlying epithelium. Clusters of plump cells showing cellular atypia with nuclear pleomorphism, prominent nucleoli, and occasional atypical mitoses extended into the subepithelial connective tissue with involvement of 1 lateral margin. A lymphocytic infiltrate was noted mainly at the edge of the lesion. The maximum tumor thickness was 0.7 mm (as measured by the Breslow method). The diagnosis was reFigure 1. Case 1. The clinical appearance of the patient at age 16 years showed a large, darkly pigmented, nodular tumor extending from the margin of the right lower eyelid to the inferior fornix.