Grey-black mass in the caruncle of palpebral conjunctiva

Introduction The gray-black mass of the conjunctival tear region is one of the clinical manifestations of palpebral conjunctival melanoma. Melanoma is a malignant tumor of melanocytes derived from the skin, mucous membranes, and pigmented areas of the central nervous system. Most malignant melanomas occur because melanin is repeatedly muffled and damaged to cause malignant transformation. Inappropriate excavation and drug corrosion can convert benign melanin into malignant melanoma. Try to avoid sun exposure. The use of sun screens is an important level of preventive measures, especially for those at high risk; strengthening the education of the general public and professionals, it is more important to find early diagnosis and early treatment.

Cause

Most malignant melanomas occur because melanin is repeatedly muffled and damaged to cause malignant transformation. Inappropriate excavation and drug corrosion can convert benign melanin into malignant melanoma.

an examination

Related inspection

Stimulating test eyes and CT examination of the temporal region

There are two classification systems available for the evaluation of stage I melanoma:

(1) According to Breslow's description, the depth from the epidermal granular layer to the deepest part of the tumor invasion is measured as the depth of melanoma.

(2) The depth of anatomy of the tumor invasion according to Clark's classification. In Clark's classification, grade I indicates that melanoma is confined to the epidermis; grade II melanoma has invaded the papillary layer of the dermis; grade III melanoma has extensively affected the papillary layer; grade IV melanoma invades the dermal reticular layer Grade V indicates that melanoma invades subcutaneous fat. Increases in Breslow thickness and depth of involvement of melanoma (Clark grade) are associated with poor prognosis.

Differential diagnosis includes basal cell carcinoma, seborrheic keratosis, dysplasia, blue sputum, cutaneous fibroids, various types of sputum, hemangioma (especially hands and feet), venous lakes, pyogenic granulomas and wart. If in doubt, a full-thickness skin biopsy that is slightly beyond the lesion must be performed. Excision biopsy was performed on small lesions, and biopsy was performed on larger lesions. Serial biopsy can determine the depth of infiltration of melanoma, and thorough radical surgery must be performed after a clear histological diagnosis.

The criteria for resection or biopsy of pigmented lesions are: recent increases in lesions, darkening, bleeding or ulceration. However, the above symptoms often indicate that melanoma has penetrated deep into the skin. When the skin lesions change color (such as brown or black mixed with red, white or blue background), irregular bumps can be seen or can be touched, and the edges are angularly serrated or notched, then the skin lesions should be immediately biopsied. Make an early diagnosis. Examination of pigmented lesions with a dermatoscope (a modified oil-impregnated eyeglass) helps distinguish melanoma and benign lesions.

Histological judgment The treatment and prognosis are primarily determined by microscopic observation of the histological depth of invasion of melanoma. Histological grading requires adequate biopsy. Central nervous system and underarm nail melanoma are generally not classified by these systems.

The depth of lymphocyte infiltration reflects the patient's immune response system and is related to the extent of invasion and prognosis. If lymphocytes infiltrate only in most superficial lesions, the chance of healing is greater. Conversely, as the depth of infiltration increases, the chance of healing decreases significantly.

Differential diagnosis

Differential diagnosis of gray and black masses in the conjunctival tears area:

1. The huge nipple of the palpebral conjunctiva: The nipple hyperplasia of the palpebral conjunctiva caused by diseases such as keratoconjunctivitis in spring, which is the giant nipple of the conjunctiva, is one of the clinical manifestations of conjunctivitis in spring. Spring keratoconjunctivitis, also known as spring catarrhal conjunctivitis, seasonal conjunctivitis. Pre-puberty onset, lasts 5-10 years, mostly for both eyes, the incidence of boys is higher than girls. The disease has a high incidence in the Middle East and Africa, low incidence in temperate regions, and almost no cases in cold regions. The incidence rate in spring and summer is higher than that in autumn and winter.

2, sacral conjunctiva hard and flat nipple: due to the clinical manifestations of catarrhal conjunctivitis in spring, at the beginning, sputum conjunctival congestion is very dramatic, followed by a lot of hard and flat nipples in the upper conjunctiva, the size is not First, on the conjunctiva of the cloth, it looks like a paving oval stone. The crack between the nipples is light blue, and the surface of the nipple presents a milky turbidity. There are not many secretions, it is very sticky, and it is drawn into a filament. For smear examination, it can be seen that eosinophils increase. If there is a lesion in the conjunctiva of the lower jaw, the nipple is small and small, and it is not as prominent as the conjunctiva.

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