A conjunctival naevus is a common pigmented lesion on the clear membrane covering the white of the eye. Many appear in childhood or early adulthood, and most are benign. On slit-lamp examination they often contain small clear cysts, which is a reassuring feature that supports a benign diagnosis. ¹
Even so, clinicians become more suspicious if a lesion:
- changes rapidly in size/colour
- becomes inflamed or develops new feeder vessels
- appears in atypical locations (fornix, tarsal conjunctiva, caruncle)
- lacks cysts and looks flat/patchy, raising concern for entities such as primary acquired melanosis (PAM)
Because appearance can overlap between benign and malignant lesions, the “gold standard” for uncertain cases is excisional biopsy with histopathology, but most typical conjunctival naevi are managed with photographic documentation and observation. ² ³
Patient-centred takeaway: if your surface “freckle” is stable and has reassuring features, monitoring is usually safer than intervention, but change or atypical location should trigger a lower threshold for specialist assessment. ¹
References
- Huang JJ, Locatelli EVT, Chocron A, Camacho MR, Dubovy S, Karp CL, et al. Conjunctival nevus. Current Ophthalmology Reports. 2023;11(4):104-112. doi:10.1007/s40135-023-00315-w. PMID: 38390435.
- Shields CL, Fasiuddin AF, Mashayekhi A, Shields JA. Conjunctival nevi: clinical features and natural course in 410 consecutive patients. Archives of Ophthalmology. 2004;122(2):167-175. doi:10.1001/archopht.122.2.167. PMID: 14990698.
- Dalvin LA, Salomão DR, Patel SV. Population-based incidence of conjunctival tumors in Olmsted County, Minnesota. British Journal of Ophthalmology. 2018;102(12):1728-1734. doi:10.1136/bjophthalmol-2017-311530. PMID: 29511061.
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