Approach to the Patient With a Neoplastic Ocular Surface Lesion
During the initial evaluation of a patient with a conjunctival or corneal neoplasm, the clinician should obtain a detailed history, including extensive sun exposure, skin cancer, or immunosuppression. The clinician should inquire about the length of time the patient has had the lesion and whether there has been any change in the lesion’s appearance. The racial or ethnic background of the patient is relevant, as conjunctival pigmentation may be normal in some patients (eg, darker-skinned persons) but worrisome in others.
A complete eye examination, including a dilated fundus examination, should be performed during the initial evaluation of the patient with a suspicious ocular surface lesion. The entire ocular surface should be examined, including the superior fornix, which requires eyelid eversion. Palpation for lymphadenopathy in the neck and preauricular region is an important part of the examination of tumor patients—especially when malignancy is suspected—because malignant lesions, especially conjunctival melanoma, can spread to regional lymph nodes. The clinical characteristics of the lesion should be noted, with the following considered:
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Is there a single lesion, or is it multifocal?
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Is the lesion pigmented or amelanotic?
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Where is it located—on the bulbar conjunctiva, at the limbus, in the fornix, on the palpebral conjunctiva?
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Does the lesion extend onto the cornea?
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Is the lesion solid or cystic?
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Is it flat or elevated?
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Is the lesion fixed to underlying tissues, or is it mobile?
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Is there a feeder vessel?
The clinician should document the appearance and extent of the lesion, using either photographs or a detailed diagram. This aids in surgical planning if the lesion is to be removed or in following the lesion if observation is recommended.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.