A 66-year-old woman with extensive conjunctival melanosis

Abstract

A 66-year-old white woman was referred to the Orbital Oncology & Ophthalmic Plastic Surgery service at The University of Texas MD Anderson Cancer Center for evaluation and management of new, extensive conjunctival pigmentation of the right eye concerning for a conjunctival neoplasm. The patient had been in her usual state of health until 5 weeks prior to presentation, when she suffered a mechanical fall onto a cement sidewalk, sustaining blunt trauma to the right side of her face and head. She had initially presented to her established local ophthalmologist 10 days following her injury complaining of right eye floaters. Examination by the outside ophthalmologist had revealed near 360-degree conjunctival pigmentation, most dense superiorly, in the right eye that had not been previously noted on routine examination 6 months prior. The patient was subsequently referred to our cancer center for evaluation and management of suspected primary acquired melanosis (PAM). The patient’s past medical history was significant for rheumatoid arthritis, coronary artery disease, and heart failure. Her past ocular history was significant for bilateral cataract extraction with intraocular lens placement.