Dermatology: Practical and Conceptual Image Letter | Dermatol Pract Concept. 2024;14(1):e2024091 1 A Growing Conjunctival Pigmentation – Videodermoscopy of Conjunctival Melanoma Lorenzo Maltoni1,2, Carlotta Baraldi1,2, Matilde Roda3, Arianna Grendele1,3, Emi Dika1,2, Sabina Vaccari1,2 1 Oncologic Dermatology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy 2 Department of Medical and Surgical Sciences, Alma Mater, University of Bologna, Bologna, Italy 3 Ophthalmolgy Unit, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy Citation: Maltoni L, Baraldi C, Roda M, Grendele A, Dika E, Vaccari S. A Growing Conjunctival Pigmentation – Videodermoscopy of Conjunctival Melanoma. Dermatol Pract Concept. 2024;14(1):e2024091. DOI: https://doi.org/10.5826/dpc.1401a91 Accepted: August 31, 2023; Published: January 2024 Copyright: ©2024 Maltoni et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Lorenzo Maltoni, MD, Dermatology, Sant’Orsola-Malpighi Hospital, Via Massarenti 1, 40138 Bologna, Italy. Phone: +39-0512144838 E-mail: lorenzo.maltoni2@studio.unibo.it Case Presentation A 60-year-old man was referred to our clinic with a history of a progressively enlarging pigmented lesion on the con- junctiva of the left eye for over 8 years. The pigmentation was unevenly distributed and affected both the paralimbal and the temporal bulbar conjunctiva (Figure 1A). The lesion was completely asymptomatic, and it did not impact the vi- sual capacity. The patient had no significant past medical history and denied any localized trauma or infection. We decided to perform a videodermoscopy of the lesion which findings reveals a predominantly dark brown structureless pattern with a touch of grayish-white veil, peripheral spots, and intralesional vessels exhibiting heteromorphic features (Figure 1, B and C). The lesion was successfully excised by removal of the affected conjunctiva and reconstruction using amniotic membrane flaps, followed by adjuvant therapy with cycles of topical mitomycin. Histological examination confirmed the diagnosis of conjunctival melanoma infiltrating the sub- epithelial connective tissue with radial extension of intracon- junctival proliferation, 1.45 mm thick (pT1b). The patient visual function was fully preserved. Teaching Point Conjunctival melanoma is a rare but extremely life- threatening malignancy neoplasm with associated mor- tality of up to 30% [1]. Mandatory is the recognition and evaluation of pigmented conjunctival lesions, especially in patients with a history of progressive growth. Videodermos- copy can aid in identifying characteristic features such as a predominantly structureless pattern, grey-white veil, and polymorphic vessels [2]. 2 Image Letter | Dermatol Pract Concept. 2024;14(1):e2024091 References 1. SKaštelan S, Gverović Antunica A, Beketić Orešković L, Salopek Rabatić J, Kasun B, Bakija I. Conjunctival Melanoma - Epide- miological Trends and Features. Pathol Oncol Res. 2018;24(4): 787-796. DOI: 10.1007/s12253-018-0419-3. PMID: 29802540. 2. Cinotti E, La Rocca A, Labeille B, et al. Dermoscopy for the Diagnosis of Conjunctival Lesions. Dermatol Clin. 2018;36(4): 439-449. DOI: 10.1016/j.det.2018.05.011. PMID: 30201153. Figure 1. (A) Black-brown pigmentation with uneven distribu- tion involving paralimbal and the temporal bulbar conjunctiva of the left eye. (B,C) Videodermoscopy findings. Predominantly dark brown structureless pattern with a touch of grayish-white veil, peripheral speckling, afferent and intralesional vessels exhibiting heteromorphic features. (B) 20X; (C) 40X.