By Phornrak Sriphon, Board Certified ophthalmologist
Black or brown spots on the white part of the eye are something many people may not have noticed before. However, once they begin to notice it, they may become concerned whether it is just a regular mole or a sign of a more serious condition. In this article, we will understand more about eye moles (Conjunctival nevus) as well as other conditions with similar characteristics, including Primary Acquired Melanosis (PAM), Complexion-Associated Melanosis (CAM), and Ocular Melanocytosis, along with diagnostic methods and treatment options.
Conjunctival nevus
Epidemiology
Studies have found that eye moles are a common condition in the general population, with a prevalence rate of 17–42%. They are found in both males and females at similar rates. From the doctor's own experience, about 50% of individuals undergoing eye exams may have an eye mole without being aware of it.
Risk factor
Although the exact cause of eye moles has not been determined, there are certain factors that may be associated with their development, including:
Hormones: Eye moles may appear at birth or develop during adolescence.
Sunlight: It is hypothesized that sunlight may affect pigment changes in the conjunctiva.
Characteristic
Conjunctival nevus can vary in appearance, including:
Color: Ranging from light yellow to dark brown or black.
Texture: It may be a smooth or raised lump.
Associated features: Some may have a cyst inside, which can indicate that it is a benign mole.
Generally, eye moles tend to remain stable. However, if the lump grows rapidly or the color darkens unusually, further examination may be necessary.ติม
Diagnosis
Doctors can diagnose a nevus in the conjunctival using a slit lamp microscopy to observe the characteristics of the lesion. If there is suspicion of malignancy, a biopsy may be performed for pathological examination.
Treatment
1.Laser treatment is one option for removing an eye nevus. Its advantages include:
Effective in removing all types of pigmentation, whether light or dark.
Performed as an outpatient procedure, eliminating the need for hospitalization.
Painless, as numbing eye drops are used before the procedure.
Disadvantages of Laser Treatment
Cannot provide a tissue sample for examination. If the lesion grows abnormally fast or has suspicious features, surgery is a better option.
Temporary eye redness may occur for about three days after the procedure.
2.Surgical Removal
If the conjunctival nevus is large, growing rapidly, or suspected to be cancerous, surgery is a better option.
In cases where a large tissue sample needs to be removed, a graft may be used to cover the excised area.
The graft can be taken from either the patient's own conjunctiva or an amniotic membrane, depending on the size of the wound.
Some doctors prefer using an amniotic membrane instead of the patient’s conjunctiva when removing a large lesion. This approach helps preserve the conjunctiva for potential future use in case of complications.
Primary Acquired Melanosis (PAM)
PAM is a condition found in adults, characterized by newly developed brown spots on the conjunctiva.
Risk of Malignant Transformation
PAM with atypia (abnormal cells) has up to a 50% risk of developing into conjunctival melanoma.
PAM without atypia (no abnormal cells) has a very low risk of malignancy (less than 1%).
Characteristics of PAM
More common in women
Appears as a smooth lesion, with color changes over time
Often found in the outer corner of the eye (temporal conjunctiva)
Typically occurs in one eye (unilateral)
If PAM is suspected, a biopsy should be performed to determine whether atypia is present.
Complexion-Associated Melanosis (CAM)
Commonly found in Asians and individuals with darker skin tones.
Appears as smooth brown spots on the conjunctiva.
Typically affects both eyes.
More common in older adults.
Not a dangerous condition, with a very low risk of malignant transformation.
Treatment Approach : No treatment is necessary, but regular follow-up examinations are recommended.Ocular Melanocytosis
Caused by the accumulation of pigment in the deep layers of the sclera.
Present from birth.
Not a dangerous condition, but in some cases, it is associated with uveal melanoma.
Treatment Approach
Regular follow-up is recommended to monitor changes in color and size.
Monitoring and Surveillance
If you have an eye nevus, regular eye exams are recommended at least every 6–12 months to:
Take photographs to compare changes over time.
Monitor the size, color, and characteristics of the lesion.
Seek medical attention promptly if the lesion grows rapidly or darkens.ที
Summary
Conjunctival nevus are common and typically not harmful.
However, if the nevus changes, such as growing rapidly or darkening, further examination is necessary.
Conditions like PAM, CAM, and Ocular Melanocytosis may carry different levels of risk.
Treatment options include laser and surgery, depending on the characteristics of the lesion.
Remember to have regular eye exams with an ophthalmologist to monitor for abnormalities and maintain the health of your eyes.
.
ReferenceHuang, J. J., Locatelli, E. V. T., Chocron, A., Camacho, M. R., Dubovy, S., Karp, C. L., & Galor, A. (2023). Conjunctival nevus. Current Ophthalmology Reports, 11(4), 104–112. https://doi.org/10.1007/s40135-023-00315-w
Alsharif, A. M., Al-Gehedan, S. M., Alasbali, T., Alkuraya, H. S., Lotfy, N. M., & Khandekar, R. (2016). Argon laser photoablation for treating benign pigmented conjunctival nevi. Middle East African Journal of Ophthalmology, 23(3), 244–248. https://doi.org/10.4103/0974-9233.186663
Disclaimer Contact
Comments