Biopsy - Nevi, Primary Acquired Melanosis, and Melanoma
Evaluation - Practical Tips!
Approach - In General
lesions often cross the limbus onto the cornea. When they do involve
the cornea, they usually involve only the corneal epithelium.
not perform lamellar dissections into the cornea to remove
lesions that straddle the limbus. Bowman's layer is a natural
barrier to the penetration of malignancies into the stroma and
if the lesion recurs after Bowman's layer has been violated surgically,
the recurrent lesion has unimpeded access to the stroma.
Approach - Specific Steps
up the affected conjunctiva with anesthetic. If the lesion separates
from the episclera after the injection, it is unlikely that the
lesion has invaded the episclera.
the lesion up to the limbus but do not dissect into the corneal
the conjunctival biopsy for the pathologist, taking care to keep
the specimen flat. Remember to tag margins appropriately. Click
here to obtain hints on handling conjunctival
the corneal epithelium is involved, instill topical anesthesia.
Then, moisten a cotton-tip applicator with absolute alcohol and
gently wipe the diseased epithelium off. You may place the glob
of epithelium onto a piece of filter paper and submit it for pathologic
WH, Folberg R: Conjunctiva. In Spencer WH (ed): Ophthalmic Pathology
- An Atlas and Textbook, 4th edition, Philadelphia, WB Saunders,
1996. pp. 125-155.
acquired melanosis with atypia, basilar hyperplasia pattern. Atypical
melanocytes are distributed primarily along the basal layer of the
epithelium in this pterygium. If untreated, 50% of lesions with
this histology may progress to conjunctival melanoma.The best treatment
for conjunctival melanoma is detection and treatment of precursor
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