Conjunctival Lesions Diagnosis and Evaluation

Clinical Presentation and Differential Diagnosis

A yellowish or brownish spot on the conjunctiva requires careful evaluation to exclude malignancy, such as conjunctival melanoma, which presents as painless, flat or nodular brown lesions on bulbar or palpebral conjunctiva, and can be flat initially, according to the American Academy of Ophthalmology 1
Sebaceous carcinoma may appear as yellowish discoloration of the tarsal plate or subconjunctival multilobulated yellow mass, and warning signs requiring urgent evaluation include enlargement of lesion, development of blood vessels, thickening, or recurrence in the same location, especially in elderly patients 2

Slit-lamp biomicroscopy is essential to evaluate location, depth, elevation, and associated findings of conjunctival lesions, as recommended by the American Academy of Ophthalmology 3
Consider biopsy for atypical features, recurrent lesions in same location, or elderly patients with history of multiple excisions, according to the American Academy of Ophthalmology 4

Conjunctival lymphoma typically appears as a painless, indolent “salmon‑patch” swelling most often located on the superior or inferior conjunctiva; up to 20 % of cases may progress to systemic disease, warranting prompt evaluation and possible referral to oncology. 5
Conjunctival melanoma presents as a painless, flat or nodular brown‑to‑white‑pink lesion that can involve adjacent adnexal structures and has the capacity to metastasize; early detection and excisional biopsy are essential to improve prognosis. [6][5]

Presence of atypical features such as irregular borders, new pigmentation changes, or intrinsic vascularization should prompt an excisional biopsy to exclude malignancy. 5
Failure of a lesion to achieve complete resolution between recurrent episodes is another criterion for biopsy, as persistent activity may indicate a neoplastic process. 5