Eye
Conjunctiva
Nevi

Author: Deepali Jain, M.D. (see Authors page)

Revised: 19 April 2018, last major update October 2014

Copyright: (c) 2004-2018, PathologyOutlines.com, Inc.

PubMed Search: Nevi conjunctiva [title]

Related Topics: Blue nevus. Inflammatory juvenile conjunctival nevus. Spitz nevus

Cite this page: Jain, D. Conjunctiva: nevi. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/eyenevi.html. Accessed July 21st, 2018.
Definition / general
  • See also Nevus of Ota in eyelid
  • Most common tumor of conjunctiva
  • Rarely invades cornea, appears in fornix or over palpebral conjunctiva
  • Rarely involves bulbar conjunctiva, caruncle, or plica semilunaris
  • May be observed at birth or later
  • May enlarge and become more pigmented at puberty or during pregnancy
  • About half of excised pigmented lesions are nevi, remainder are melanomas or primary acquired melanosis
Case reports
Treatment
  • Excision or watchful waiting, only rarely transforms (1 per 150K)
  • Excise if newly acquired in adults, clinical growth, change in pigmentation, cosmetic reasons
Clinical images

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Various images

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Balloon cell nevus

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Variations in pigmentation

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Variations in size


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Variations in location

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Variations in associated clinical features

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Variations in clinical appearance

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Change in nevus appearance over time

Gross description
  • Discrete, flat or slightly elevated; circumscribed, pink, yellow-tan, brown or nonpigmented, in interpalpebral zone near limbus; 1/3 are amelanotic
Microscopic (histologic) description
  • Nevomelanocytes organized into intraepithelial nests of oval cells (type A), sheets of oval to cuboidal cells (type B), and spindled cells in subepithelium (type C)
  • Often (50%) with solid and prominent cystic inclusions of conjunctival epithelium and chronic inflammatory infiltrate
  • May have atypical features and mitotic figures during growth periods
  • Compound (70 - 78%):
    • Most common, nevi cells in epithelium and subepithelial connective tissue
    • Cells have cysts lined by cuboidal and goblet cells and intranuclear inclusions
    • May have large pigmented cells with prominent basophilic nucleoli
    • Usually mixed inflammatory cells
  • Junctional (5%):
    • Contiguous nests of round / spindle melanocytes near basal cell region with oval nuclei, small nucleoli
    • Nucleoli may be basophilic and prominent but no atypia
    • Uncommon except in young children
    • Resembles primary acquired melanosis with atypia
  • Subepithelial (9%):
    • Nevus cells only in subepithelial connective tissue, no pigment, bland nuclei
    • May have clear cytoplasm due to lipid and central round nucleus (balloon cell nevus)
Microscopic (histologic) images

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Compound nevus - variability in cytology

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Atypical compound nevus-melanocytes in junctional
area mature into smaller and less hyperchromatic
cells as they extend deeper into lamina propria



Cystic compound nevus:
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Figure 1

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Figure 2

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Figure 4


Fig 1: Multiple large cysts
Fig 2: Nevoid cells in junctional area around cystic spaces
Fig 3: Sheets of melanocytes with variable-sized cysts
Fig 4: Diffuse proliferation of melanocytes, with cysts lined by conjunctival epithelium with goblet cells



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Benign nevus (B), amelanotic nevus (C)

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Conjunctival nevi

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Epithelioid cell (clonal or inverted) nevi

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Granular cell nevus

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Subepidermal (A), compound (B),
cystic (C), intraepithelial (D),
and juvenile (E&F)



Balloon cell:
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Various images

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Balloon cell compound nevus
composed of large clear cells

Differential diagnosis