Track

Case Reports

Abstract

Case: 

A 69-year-old female with Fitzpatrick Type V skin presented with a 3-month history of a friable, black mass of right upper tarsus conjunctiva that interfered with her activities of daily living. A clinical exam revealed an approximately 7 x 4 mm firm, exophytic black tumor with a white, exudative-appearing surface on the upper tarsal conjunctiva and a 4 mm x 3mm hyperpigmented macula on the lower fornix conjunctiva.  Given the concern for melanoma, an excision was performed by an oculoplastic surgeon.  

The excision of the upper tarsal tumor consisted of a 0.7 x 0.5 x 0.1 cm piece of eyelid and a detached, 0.3 x 0.3 cm tissue fragment. Histopathologic examination of the detached fragment revealed cornified cells with melanin pigment. At the periphery, there was a thin rim of basaloid cells with abrupt keratinization. The eyelid skin revealed a slightly eroded junctional proliferation of spindled and epithelioid melanocytes with abundant melanin pigment that appeared to be underlying the detached fragment. The lower fornix conjunctiva excision demonstrated hyperpigmentation and a slightly increased concentration of junctional melanocytes with an accompanying lymphohistiocytic infiltrate.  

Discussion: This case illustrates a rare, and diagnostically challenging example of a pilomatricoma admixed with a junctional melanocytic nevus and conjunctival lentigo.