1. Benign• Naevus• Papilloma• Epibulbar dermoid• Lipodermoid

2. Pre-malignant• Primary acquired melanosis ( PAM )• Intraepithelial neoplasia (carcinoma in situ)

3. Malignant• Melanoma• Squamous cell carcinoma• Kaposi sarcoma• Lymphoma

CONJUNCTIVAL TUMOURS

Naevus

• 30% are almost non-pigmented

• Most frequently juxtalimbal• Sharply demarcated and slightly elevated

• Presents in first two decades

PapillomaPedunculated Sessile

• Presents in middle age• Not caused by infection• Single and unilateral

• Presents in childhood or early adulthood• Infection with papilloma virus • May be multiple and bilateral

• Presents in childhood• Smooth, soft mass• Usually juxtalimbal

• Occasionally Goldenhar syndrome

Epibulbar dermoidSigns Association

Lipodermoid

• Presents in adulthood• Soft, movable, subconjunctival mass• Most frequently at outer canthus

Intraepithelial neoplasia(carcinoma in situ)

• Juxtalimbal fleshy avascular mass

• May become vascular and extend onto cornea

• Presents in late adulthood

• Malignant transformation is uncommon

Signs Progression

Primary acquired melanosis (PAM)

• PAM without atypia is benign• PAM with atypia is pre-malignant • Unilateral, irregular areas of flat,

brown pigmentation• May involve any part of conjunctiva

• Presents in late adulthood

Signs Types

Conjunctival melanoma

From PAM with atypia

• Sudden appearance of nodules in PAM

From naevus

• Sudden increase in size or pigmentation

Primary

• Solitary nodule• Frequently juxtalimbal but may be anywhere

• Very rare• Most common type

Localized tumour

• Excision

Treatment of conjunctival melanoma

Diffuse tumour

• Excision of nodules

Orbital recurrence

• Excision and radiotherapy• Adjunctive cryotherapy or

mitomycin C • Exenteration• Adjunctive cryotherapy

Squamous cell carcinoma

• Rarely metastasizes

• Arises from intraepithelial neoplasia or de novo

• Frequently juxtalimbal

• Slow-growing

• Presents in late adulthood• May spread extensively

Signs Progression

Kaposi sarcoma

• Most frequently in inferior fornix

• Affects patients with AIDS• Vascular, slow-growing tumour of low malignancy• Very sensitive to radiotherapy

Lymphoma

• Salmon-coloured, subconjunctival infiltrate

• Usually presents in adulthood• Benign or malignant