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1. Benign

CONJUNCTIVAL TUMOURS. 1. Benign. Naevus. Papilloma. Epibulbar dermoid. Lipodermoid. 2. Pre-malignant. Primary acquired melanosis ( PAM ). Intraepithelial neoplasia (carcinoma in situ ). 3. Malignant. Melanoma. Squamous cell carcinoma. Kaposi sarcoma. Lymphoma.

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1. Benign

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  1. CONJUNCTIVAL TUMOURS 1. Benign • Naevus • Papilloma • Epibulbar dermoid • Lipodermoid 2. Pre-malignant • Primary acquired melanosis ( PAM ) • Intraepithelial neoplasia (carcinoma in situ) 3. Malignant • Melanoma • Squamous cell carcinoma • Kaposi sarcoma • Lymphoma

  2. Naevus • Most frequently juxtalimbal • Presents in first two decades • Sharply demarcated and slightly • elevated • 30% are almost non-pigmented

  3. Papilloma Pedunculated Sessile • Presents in middle age • Presents in childhood or early adulthood • Not caused by infection • Infection with papilloma virus • May be multiple and bilateral • Single and unilateral

  4. Epibulbar dermoid Signs Association • Presents in childhood • Occasionally Goldenhar • syndrome • Smooth, soft mass • Usually juxtalimbal

  5. Lipodermoid • Presents in adulthood • Soft, movable, subconjunctival mass • Most frequently at outer canthus

  6. Intraepithelial neoplasia (carcinoma in situ) Signs Progression • May become vascular and extend onto • cornea • Presents in late adulthood • Malignant transformation is uncommon • Juxtalimbal fleshy avascular mass

  7. Primary acquired melanosis (PAM) Signs Types • Presents in late adulthood • PAM without atypia is benign • PAM with atypia is pre-malignant • Unilateral, irregular areas of flat, • brown pigmentation • May involve any part of conjunctiva

  8. Conjunctival melanoma From naevus Primary From PAM with atypia • Very rare • Most common type • Solitary nodule • Sudden appearance of • nodules in PAM • Frequently juxtalimbal • but may be anywhere • Sudden increase in size • or pigmentation

  9. Treatment of conjunctival melanoma Localized tumour Diffuse tumour Orbital recurrence • Excision • Excision of nodules • Excision and • radiotherapy • Adjunctive cryotherapy • Adjunctive cryotherapy or • mitomycin C • Exenteration

  10. Squamous cell carcinoma Signs Progression • Arises from intraepithelial • neoplasia or de novo • Slow-growing • May spread extensively • Presents in late adulthood • Rarely metastasizes • Frequently juxtalimbal

  11. Kaposi sarcoma • Affects patients with AIDS • Vascular, slow-growing tumour of low malignancy • Very sensitive to radiotherapy • Most frequently in inferior fornix

  12. Lymphoma • Usually presents in adulthood • Benign or malignant • Salmon-coloured, subconjunctival infiltrate

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