Jimura Hironobu, Mishima Yuuki, Sotozono Chie, Watanabe Akihide, Asai Jun, Ohbayashi Chiho, Ogata Nahoko
Department of Ophthalmology, Nara Medical University, Nara, Japan.
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Int Med Case Rep J. 2021 May 28;14:361-364. doi: 10.2147/IMCRJ.S310702. eCollection 2021.
Primary acquired melanosis (PAM) of the conjunctiva is a potentially serious melanocytic lesion that can lead to the development of a melanoma. A 60-year-old woman noticed pigmentation of the conjunctiva of her left eye for more than 10 years. She underwent excisional biopsy combined with cryotherapy and was diagnosed with PAM without atypia by intraoperative consultation. She was followed for 7 years, and no changes were observed. Fourteen years after the initial biopsy, she noted a growing conjunctival tumor, and a melanoma was suspected. She underwent orbital exenteration and skin grafting procedures. Histopathological examination of the specimen led to a diagnosis of conjunctival malignant melanoma. Re-examination of the initial biopsy specimen revealed that there was a proliferation of melanocytes that partially expanded over the basal layer of the conjunctiva which had been diagnosed as PAM with moderate atypia. We conclude that this case of conjunctival PAM had progressed to a conjunctival malignant melanoma after 14 years. Pathological evaluation of intraepithelial lesions has its limitations; thus, cases of PAM, even in the absence of obvious atypia, require careful follow-up.
结膜原发性获得性黑变病（PAM）是一种潜在的严重黑素细胞病变，可导致黑色素瘤的发生。一名60岁女性发现其左眼结膜色素沉着超过10年。她接受了切除活检并联合冷冻治疗，术中会诊诊断为无异型性的PAM。对她进行了7年的随访，未观察到变化。初次活检14年后，她注意到结膜肿物增大，怀疑为黑色素瘤。她接受了眼眶内容剜除术和皮肤移植手术。标本的组织病理学检查确诊为结膜恶性黑色素瘤。对初次活检标本的重新检查显示，存在黑素细胞增殖，部分扩展至结膜基底层，最初诊断为中度异型性的PAM。我们得出结论，该例结膜PAM在14年后进展为结膜恶性黑色素瘤。上皮内病变的病理评估存在局限性；因此，即使没有明显异型性，PAM病例也需要仔细随访。
