Benign conjunctival melanocytic lesions. Clinicopathologic features.

The common acquired conjunctival nevus usually undergoes progressive maturation and only exceptionally gives rise to conjunctival melanoma. Pure junctional nevi are rare except in childhood. Histologically, however, a junctional nevus may be indistinguishable from primary acquired melanosis (PAM) with atypia, a condition of middle-aged and elderly individuals that has a tendency to evolve into melanoma. Nevi in adolescents may attract a vigorous lymphocytic response and may cause clinical and histologic confusion with other entities, particularly a regressing nodule of melanoma that occurs predominantly in adults. Rarely, congenital conjunctival nevi are identified, sometimes in patients with adjacent congenital nevi of the eyelid. A variety of unusual nevi, including balloon-cell nevi, Spitz nevi, epithelioid cell nevi, dysplastic nevi, recurrent nevi, episcleral melanosis and the nevus of Ota, blue and cellular blue nevi, melanocytoma, and composite or mixed nevi all may be identified in the conjunctiva. Concepts of histogenesis as well as the clinical, light microscopic, and ultrastructural features of these and other benign pigmentary conditions of the conjunctiva are described.

Hepatic metastasis and orbital recurrence of uveal melanoma after 42 years.

A 70-year-old woman who had undergone enucleation of the left eye at the age of 28 years because of complications from an injury to the globe, and in whom a previously unsuspected posterior uveal melanoma was detected after enucleation, had no further problems until 42 years later, when she was discovered to have a liver malignancy of undetermined origin. After six months of chemotherapy, the patient developed a mass in the anophthalmic left orbit. Biopsy of the orbital mass disclosed malignant melanoma, and reexamination of the liver biopsy specimen disclosed similar malignant melanoma cells. The patient had no clinical evidence of a primary melanoma other than the one involving the eye. It is possible that the patient had subclinical melanoma cells in the liver for 40 years. However, another possibility is that the patient had residual melanoma cells in the orbit which eventually metastasized to the liver.

Blue nevi of the conjunctiva.

Two examples of conjunctival blue nevi are presented. The clinical and histologic features of these lesions are not in accord with descriptions of blue nevi in the ophthalmic literature. In both cases, the nevi's clinical appearance was brown instead of blue; the nevi could be moved with the conjunctiva over the sclera; and they were not present at birth. Histologically, they demonstrated subepithelial, spindle-shaped melanocytes. The location of the cells was no deeper than that of common acquired compound or subepithelial conjunctival nevi.

Quantitated trauma following radial keratotomy in rabbits.

Radial keratotomy was performed in 33 rabbits using an eight-incision technique. At various postoperative intervals up to 90 days, these eyes were enucleated and subjected to increasing quantitated trauma until ocular rupture occurred. Control animals (13 eyes) were subjected to similar trauma. The eyes that had surgery required approximately 50% of the control energy to rupture over the 90-day period (P less than 0.001). Corneal microperforations at surgery greatly increased the trauma risk (P = 0.02). Consistent rupture patterns resulted, both grossly and microscopically.

Retinal pigment epithelial abnormalities in fundus flavimaculatus: a light and electron microscopic study.

Light, fluorescent, and scanning and transmission electron microscopic examinations of two postmortem eyes from a 24-year-old man with well-documented fundus flavimaculatus with atrophic macular degeneration revealed striking abnormalities in the retinal pigment epithelium (RPE). Beginning near the equator, scanning electron microscopy demonstrated a progressively marked heterogeneity in the size of the RPE cells. Surrounded by a fairly regular mosaic of relatively normal appearing cells, enormously enlarged hypomelanotic cells measuring up to 80 microns in diameter occurred in irregular aggregates that became more prevalent posteriorly. Diffusely and intensely PAS-positive, the RPE was packed with a granular substance with ultrastructural, autofluorescent, and histochemical properties consistent with an abnormal form of lipofuscin. The greatest concentration of lipopigment was noted posteriorly. Stains for acid mucopolysaccharide were only mildly positive. The clinical and fluorescein angiographic manifestations of fundus flavimaculatus are consistent with accumulation of a lipofuscin-like substance in the RPE. The massive amounts of lipopigment encountered in this young individual suggest that disordered lipopigment metabolism may play a major role in the pathogenesis of this retinal pigment epithelial disorder.

Melanocytic lesions of the eyelid skin.

We described the three histogenetic forms of cutaneous melanoma--lentigo maligna melanoma, superficial spreading melanoma, and nodular melanoma. The first two forms have a flat spreading component or radial growth phase in the epithelium as well as in the invasive or vertical growth phase. Formerly these two lesions may have been confused with one another. Nodular melanoma has only the vertical growth phase. Examples of lentigo maligna melanoma and superficial spreading melanoma were found in eyelid lesions involving both the skin and conjunctiva. The distinctive histopathology of the cutaneous lesion was retained in the conjunctiva.

Malignant melanomas of the conjunctiva.

A retrospective study of 23 conjunctival melanomas using the Clark classification revealed that the three most common forms of melanoma described in the skin--lentigo maligna melanoma (Hutchinson's freckle with melanoma), superficial spreading melanoma, and nodular melanoma--can be recognized in the conjunctiva. As in the skin, lentigo maligna melanoma appears to be associated with a good prognosis compared to the prognosis associated with superficial spreading melanoma. These two forms of melanoma are both associated with an intraepithelial stage and had previously been grouped under one designate, cancerous melanosis. They can be distinguished histologically although definite clinical differentiation will be determined in the future. Some melanomas with an intraepithelial stage, however, cannot be definitely classified. Relating all conjunctival cancerous melanoses to Hutchinson's melanotic freckle is no longer justified.

Cataracts in bleomycin-treated rats.

Bleomycin was administered to 126 normal or human-tumor-bearing baby rats we observed for the development of cataracts. Eighty-four percent of the rats receiving this drug before the age of 10 days developed lens opacities. Bleomycin given to 10-day-old rats or older did not induce cataract formation. The cataracts initially occurred in the nuclear area and later involved most of the lens whether or not bleomycin was later discontinued. The presence of the tunica vasculosa lentis in rats younger than 10 days old may explain why cataracts developed only in these young animals.