Department of Ocular Oncology, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK.
NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK.
Eye (Lond). 2021 Sep;35(9):2579-2584. doi: 10.1038/s41433-020-01273-4. Epub 2020 Nov 16.
The objective of this study is to characterise the natural history of conjunctival naevi in a paediatric and adolescent population.
All children and adolescents referred to Moorfields Ocular Oncology Service for evaluation between January 2015 and 2020 were included. Exclusion criteria included age >20 years old and lack of anterior segment photographs. A total of 77 patients were included with a mean age of 12 years (standard deviation: 3.9; range, 4-20). The main outcome measures were: number of conjunctival naevi that grew, changed in pigmentation, required excisional biopsy, or were histologically malignant. If there was growth, the percentage increase in size was measured.
At their first visit, 13% of patients (10/77) were discharged to local follow-up and 10% (8/77) proceeded to excisional biopsy, four further patients underwent excisional biopsy after a period of follow-up. On histopathological assessment, 92% (11/12) of lesions were benign conjunctival naevi. One patient, who had suspicious clinical features at presentation, had conjunctival melanoma. Fifty-nine patients were followed over a median of 1.1 years (interquartile range: 1.54; range, 3 months to 4 years). Eight per cent (5/59) of conjunctival naevi enlarged in diameter by a mean percentage increase in size of 2%, whereas 5% (3/59) showed increased pigmentation and 8.5% (5/59) showed decreased pigmentation.
Growth of conjunctival naevi in children is infrequent (8%) and the large majority of those excised are benign. Because of a lack of evidence, these patients are often followed for years in ophthalmic practice. This series demonstrates that prolonged follow-up may not be necessary.
本研究旨在描述儿童和青少年群体中结膜痣的自然病程。
纳入 2015 年 1 月至 2020 年期间因评估就诊于莫尔菲尔德眼肿瘤服务中心的所有儿童和青少年患者。排除标准包括年龄>20 岁和缺乏眼前节照片。共纳入 77 例患者，平均年龄为 12 岁（标准差：3.9；范围，4-20）。主要观察指标为：结膜痣数量的增长、色素改变、需要进行切除活检或组织学恶性。如果有增长，则测量其大小的百分比增加。
在首次就诊时，13%的患者（10/77）被转至当地随访，10%（8/77）行切除活检，4 例患者在随访一段时间后行切除活检。组织病理学评估显示，92%（11/12）的病变为良性结膜痣。1 例患者临床表现可疑，诊断为结膜黑色素瘤。59 例患者的中位随访时间为 1.1 年（四分位距：1.54；范围，3 个月至 4 年）。8%（5/59）的结膜痣直径增大，平均百分比增加 2%，5%（3/59）的结膜痣色素增加，8.5%（5/59）的结膜痣色素减少。
儿童结膜痣的生长较为罕见（8%），且大多数切除的痣为良性。由于缺乏证据，这些患者在眼科临床实践中通常需要随访多年。本系列研究表明，延长随访时间可能并非必要。
