in the body. Occasionally, it may be localized to the episclera and sclera and may be mistaken for scleromalacia perforans [190]. Biopsy of melanocytoma does not seem to increase its lethality, and may prevent unnecessary mutilation [191]. Treatment consists of either exenteration or wide local excision depending on location; radiotherapy may be effective in those melanocytomas arising from acquired melanosis.

8.4.8Secondary Tumors

Although episcleral and scleral secondary tumors from conjunctiva are not uncommon, episcleral and scleral secondary tumors from anywhere in the body are rare [38]. Occasional cases have been reported arising from seminoma, breast carcinoma, skin melanoma, or generalized systemic lymphomatous disease [102, 192, 193].

8.5Summary

Noninflammatory affections of the sclera may be manifestations of ocular diseases, such as the connective tissue abnormalities, degenerations, or tumors. They also may be signs of systemic diseases, such as metabolic disorders, connective tissue abnormalities, or hematologic disorders. In many cases, the characteristics of the scleral abnormality (deposit, thinning, thickening, or mass) are sufficiently distinctive that the ocular or systemic diagnosis is first suspected by the ocular presentation. Ophthalmologists must be competent enough to recognize this interconnection and therefore, promptly diagnose and, if possible, treat the underlying ocular or systemic disease.

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