This guideline last updated 06/05/2022 17:47:56

Differential diagnosis

• Conjunctival intraepithelial squamous neoplasia

Possible management by Optometrist

Treatment

• None

Advice

• Ethnic melanosis has no malignant potential and requires no treatment
• Naevus
  • Advise patient to report any increase in size, elevation or colour
  • Review after 6 months and then every 12 months if lesion unaltered
• Generally requires no treatment
• Photo-documentation advised
• Very rarely progresses to a malignant melanoma 
• Congenital Ocular Melanocytosis
• Screen regularly for glaucoma
• Primary Acquired Melanosis
• Mild cases can be observed
• Any atypical features or change should be referred
• Malignant Melanoma
• Refer urgently

Management Category

• Refer urgently
  • Melanoma (within one week)
• Refer routinely
  • Primary Acquired Melanosis/Conjunctival-Melanolcytic Intra-Epithelial Neoplasia
  • Naevus if atypical, especially if non-bulbar conjunctiva is involved
  • Congenital Ocular Melanocytosis

Possible management by Ophthalmologist

• Biopsy
• Excision with double freeze-thaw cryotherapy to excised margins
• Exenteration if unresectable