Melanoma is suspected when the lesion appears as a thickened brown, tan, or pink mass with feeder and intrinsic vascularity. Early detection is instrumental in reducing metastasis. Recognition of factors that lead to conjunctival melanoma, such as primary acquired melanoma (PAM), can help. The clinical features of PAM include a flat, intraepithelial pigmentation that is unilateral, patchy, and multifocal, particularly when there is tarsal, forniceal, or corneal epithelial pigment. PAM can be of any size and can involve tarsal and forniceal sites, whereas it would be distinctly unusual to find a nevus in these locations. The management of PAM depends on a variety of factors, but Dr. Sheilds recommends that PAM of greater size should be considered for treatment.