Malignancy Status and Features of 5,002 Conjunctival Tumors
By Lynda Seminara and edited by Richard K. Parrish II, MD
American Journal of Ophthalmology, December 2016
There are many types of conjunctival neoplasms, and differential diagnosis can be challenging. Shields et al. performed a statistical analysis of conjunctival tumor types and clinical features for a large series of patients. The authors identified properties that differentiate malignant tumors from their benign/premalignant counterparts and found that certain clinical characteristics are associated with specific conjunctival tumors.
The retrospective review included 4,625 patients (5,002 tumors) with a conjunctival tumor who presented to the ocular oncology service of Wills Eye Hospital from 1974 to 2015. Diagnoses were compared among age brackets, races, sexes, and tumor findings (e.g., color, size, predominant localization). Features of malignant conjunctival tumors were compared with those of benign/premalignant counterparts because malignancies usually originate from or resemble the corresponding benign versions.
The most common lesion was nevus (23%). A majority of tumors (52%) were benign; 30% were malignant and 18% were premalignant. Malignant tumors included melanoma (12%), squamous cell carcinoma (9%), and lymphoma (7%).
Compared with primary acquired melanosis, conjunctival melanoma was significantly associated with advanced age, Caucasian race, male gender, larger lesion size, and specific location and vascular hallmarks. Squamous cell carcinoma generally was larger, more diffuse, and more commonly pigmented than conjunctival intraepithelial neoplasia. Compared with benign reactive lymphoid hyperplasia, lymphoma was more likely to be larger, exhibit specific localization patterns, and occur in elderly patients.
The authors concluded that malignant conjunctival tumors generally exceed benign tumors in diameter and thickness and occur more frequently in older patients. The identification of statistical associations for conjunctival neoplasms can inform clinical and surgical decision making and can improve clinical recognition of malignancy. However, the authors cautioned that their results may reflect overrepresentation of serious malignancies and of tumors common to Caucasians.
The original article can be found here.