Ahmad, Khabir

Channa, Roomasa

Chaudhry, Tanveer Anjum

Memon, Sana Shoukat

English

eCommons@AKU

eCommons@AKUDepartment of Surgery Department of SurgeryFebruary 2008Conjunctival malignant melanoma mimicking as achalazionSana Shoukat MemonAga Khan UniversityRoomasa ChannaAga Khan UniversityTanveer Anjum ChaudhryAga Khan University, tanveer.chaudhry@aku.eduKhabir AhmadAga Khan University, khabir.ahmad@aku.eduFollow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_surg_surgPart of the Ophthalmology Commons, and the Surgery CommonsRecommended CitationMemon, S., Channa, R., Chaudhry, T., Ahmad, K. (2008). Conjunctival malignant melanoma mimicking as a chalazion. Pak JOphthalmol, 24(2), 104-105.Available at: http://ecommons.aku.edu/pakistan_fhs_mc_surg_surg/367104 Case Report  Conjunctival Malignant Melanoma Mimicking As a Chalazion  Sana Shoukat Memon, Roomasa Channa, Tanveer A. Chaudhry, Khabir Ahmad  Pak J Ophthalmol 2008, Vol. 24 No. 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . .  See end of article for authors affiliations  …..………………………..  Correspondence to: Tanveer A Chaudhry  Section of Ophthalmology Department of Surgery  Aga Khan University Karachi   Received for publication May’ 2007 …..………………………..              onjunctival melanoma is an uncommon tumour with an incidence of 0.3-0.8 cases / million population. It is likely to recur and carries an overall mortality rate of approximately 30 %.  The mean age at diagnosis is 53 years (± 11 years) and like other tumours, its incidence increases with advancing age and sun exposure1,2.  CASE  A 35-year-old man was referred by his family physician to our eye clinic for the management of a chalazion on his right upper lid. According to the patient, he had a slowly growing painless swelling of recent onset over his right upper lid. He did not have any other complaints. Eye examination revealed a firm, non-tender swelling in the middle of the right upper lid. On everting the upper lid, the lesion on the conjunctival side did not look like a typical chalazion (Fig. 1). It was rather a vascular lesion, surrounded by a pigmented area. Local lymph nodes were not palpable and no similar lesion was found elsewhere on his body. The rest of the systemic examination was unremarkable. After taking his consent, a complete resection of the lesion was performed under local anesthesia. Histopathology of the lesion revealed a conjunctival malignant melanoma with clear edges. Further biopsies were taken 3600 around the site of the lesion which also revealed clear edges. Liver function tests and abdominal ultrasonography were normal. The patient was followed regularly and one and a half year after the initial excision there was no sign of recurrence. As mentioned earlier, conjunctival melanoma is a rare tumour, but is likely to recur and has a very high mortality rate-around 30%. Advancing age and sun exposure are important risk factors. As our patient was relatively younger, the clinical suspicion for a malignancy was very low.  The different presentations of conjunctival melanoma reported in literature include occurrence of bloody tears and rapidly C 105 growing mass3,4. However, to the best of our knowledge, this is the first case where conjunctival malignant melanoma was presenting as a chalazion. Various lesions of the lids and eyes are confused as chalazion by physicians. Ozdal et al reported that5, amongst the malignancies misdiagnosed as chalazia, the most common were sebaceous cell carcinoma and basal cell carcinoma. Conjunctival melanoma was not mentioned as a possible misdiagnosis.    Fig: Vascularised, pigmented lesion noted on lid eversion.  CONCLUSION Chalazion is a common benign eyelid cyst which is easily treatable by an incision and curettage. Rarely some malignancies can mimic chalazion in their presentation. Every chalazion, especially the ones on the upper eyelid, should be thoroughly examined before treatment and in case of recurrence should be biopsied for histopathological examination. We suggest that although conjunctival melanoma is a rare tumour, the possibility of a significant differential for a slowly growing mass in the lid and early detection and treatment is vital due to the high mortality and metastases rates. Author’s affiliation Dr. Sana Shoukat Memon Section of Ophthalmology, Department of Surgery, Aga Khan University P O BOX 3500, Stadium Road Karachi Dr. Roomasa Channa Section of Ophthalmology, Department of Surgery, Aga Khan University P O BOX 3500, Stadium Road Karachi Dr. Tanveer A. Chaudhry Section of Ophthalmology, Department of Surgery, Aga Khan University P O BOX 3500, Stadium Road Karachi Dr. Khabir Ahmad Section of Ophthalmology, Department of Surgery, Aga Khan University P O BOX 3500, Stadium Road Karachi  REFERENCE 1. Lommatzsch PK, Werschnik C. Malignant conjunctival melanoma. Clinical review with recommendations for diagnosis, therapy and follow-up. Klin Monatsbl Augenheilkd. 2002; 219:710-21. 2. Seregard S. Conjunctival melanoma. Surv Ophthalmol. 1998; 42:321-50. 3. Duchateau N, Meyer A, Hugol D, et al. Nodular melanoma on primary acquired conjunctival melanosis. J Fr Ophtalmol. 2005; 28: 331-5. 4. Biswas MC, Dutta S, Nath U, et al. Malignant melanoma of conjunctiva-a case report. J Indian Med Assoc. 2004; 102: 730-64. 5. Ozdal PC, Codere F, Callejo S, et al. Accuracy of the clinical diagnosis of chalazion. Eye 2004; 18: 135-8.  

Conjunctival malignant melanoma mimicking as a chalazion

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Conjunctival malignant melanoma mimicking as a chalazion

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