The figure demonstrates an elevated, irregular, pigmented lesion most consistent with a conjunctival melanoma. Clinical features that portend a poor prognosis include increased tumor thickness, unfavorable location (caruncle, palpebral conjunctiva, fornix), and invasion into deeper ocular structures. Histologic features that portend a poor prognosis include mixed cell type, lymphatic invasion, moderate-to-severe atypia, greater than 5 mitotic figures per 10 high-power fields, and lack of an inflammatory response induced by the tumor.