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Melanocytic Nevi of the Tarsal Conjunctiva: Clinicopathologic Case Series With Review of Literature

Kim, Hyunjin Jane M.D.*; McCormick, Steven A. M.D.†‡; Nath, Sanjeev M.D.†§; Moskowitz, Bruce M.D.; Milman, Tatyana M.D.*†‡

Ophthalmic Plastic & Reconstructive Surgery: November-December 2010 - Volume 26 - Issue 6 - p 438-442
doi: 10.1097/IOP.0b013e3181d18a64
Original Articles

Purpose: To describe 4 patients with histopathologically confirmed tarsal conjunctival nevi and to review the literature regarding nevi in this location.

Methods: Clinicopathologic series of 4 cases diagnosed at the New York Eye and Ear Infirmary between January 1990 and April 2009. PubMed was searched for reported cases of tarsal conjunctival nevi.

Results: Four patients (mean age 44 years, median 50 years, range 5–70 years) with tarsal conjunctival nevi were identified (3.4% of all histopathologically diagnosed conjunctival nevi). These lesions presented in adulthood (3 cases) and were associated with elevation/nodularity (3 cases), gray-brown coloration (3 cases), physician-documented growth (1 case), madarosis (1 case), and intrinsic vessels (1 case). Histopathology revealed combined nevi centered in the posterior lamella of the eyelid, predominantly in peri-Meibomian gland distribution. Review of the literature identified 10 previously reported cases of tarsal nevi with detailed clinicopathologic correlation in 3 of these patients.

Conclusions: Tarsal conjunctival nevi are rare. Adult presentation; subjective and objective evidence of growth; and associated inflammation, vascularity, and eyelid margin changes may make clinical distinction of tarsal nevi from melanoma challenging. Biopsy, therefore, is prudent as histopathology alone allows documentation of the benign nature of these lesions.

A clinicopathologic case series of 4 patients with tarsal conjunctival nevi is described. Adult presentation, evidence of growth, presence of intrinsic vessels, and distortion of the lid margin associated with pigmented tarsal lesion warrant biopsy to distinguish nevi from melanoma.

*Department of Ophthalmology, New Jersey Medical School, Newark, New Jersey; Departments of †Ophthalmology and ‡Pathology and Laboratory Medicine, The New York Eye and Ear Infirmary; and §Eye Institute and Laser Center, New York, New York, U.S.A.

Accepted for publication December 23, 2009.

The authors have no proprietary interests or financial disclosures related to this study.

Supported by the NYEEI Pathology Research Fund (to T.M.), Research to Prevent Blindness Inc. (to T.M. and H.J.K.), and the Lions Eye Research Foundation of New York and New Jersey (to T.M. and H.J.K.).

Address correspondence and reprint requests to Tatyana Milman, M.D., The New York Eye and Ear Infirmary, 310 East 14th Street, New York, NY 10003, U.S.A. E-mail:

©2010The American Society of Opthalmic Plastic and Reconstructive Surgery, Inc.