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104 

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 

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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 

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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.