Compound Nevus Simulating a Conjunctival Melanoma

A 50‐year‐old woman presented with a brownish‐black inferior limbal mass for many years with rapidly increasing in size and encroaching on the cornea of the right eye over the past year. The clinical examination revealed a dark brown, elevated and irregular mass adhering to the underlying sclera and cornea with four feeder vessels [Figure 1a]. The mass had a maximum basal diameter of 8.0 mm and thickness of approximately 0.6 mm. Ultrasound biomicroscopy revealed no involvement of the angles [Figure 2a]. The patient was scheduled for an excisional biopsy. Intraoperatively, alcohol‐assisted corneal epitheliectomy and excision using the “no‐touch technique” with lamellar sclerectomy were performed. The margins of the conjunctiva were treated with double freeze–thaw cryotherapy, and amniotic membrane was transplanted [Figures 1b‐d]. On histopathological analysis performed in our patient [Figures 2b and 3], the section examined under hematoxylin and eosin staining showed stratified squamous lining epithelium, which had a lesion with nests and sheets of nevus cells containing melanin. The cells were of three types: upper layer with abundant cytoplasm, lymphoid‐like and melanin containing middle layer, and spindle shaped lower layer. The nevus cells appeared to drop off from the epithelium into the Compound Nevus Simulating a Conjunctival Melanoma