CHAPTER 8

Clinical Approach to Neoplastic Disorders of the Conjunctiva and Cornea

In the United States, approximately 1 person in 2500 seeks ophthalmic care for a tumor of the eyelid or ocular surface each year—about 100,000 total. Benign neoplasms are at least 3 times more frequent than malignant lesions. Most of these tumors arise from the eyelid skin and are discussed in BCSC Section 4, Ophthalmic Pathology and Intraocular Tumors, and Section 7, Orbit, Eyelids, and Lacrimal System.

Neoplastic tumors of the conjunctiva and cornea are considered together because the lesions can affect both tissues concurrently. These lesions are classified by cell type: epithelium, melanocytes and nevus cells, vascular endothelium, mesenchymal cells, and lymphocytes. Many are analogous to lesions affecting the eyelid. See BCSC Section 4, Ophthalmic Pathology and Intraocular Tumors, for additional discussion of conjunctival and corneal neoplastic lesions.

Shields CL, Shields JA. Tumors of the conjunctiva and cornea. In: Tasman W, Jaeger EA, eds. Duane’s Ophthalmology on DVDROM, 2012 Edition. Philadelphia: Lippincott Williams & Wilkins; 2012:chap 10.

Shields JA, Shields CL. Eyelid, Conjunctival, and Orbital Tumors: An Atlas and Text. Phila​delphia: Lippincott Williams & Wilkins; 2008.

Approach to the Patient With a Neoplastic Conjunctival Lesion

At the initial evaluation of a patient with a conjunctival neoplasm, the clinician should obtain a detailed history, including any history of extensive sun exposure or of skin cancer. The clinician should inquire about the length of time the patient has had the lesion and whether there has been any change in the lesion’s appearance. The racial or ethnic background of the patient is relevant, as conjunctival pigment may be normal in some patients (eg, those with pigmented skin) but more worrisome in others.

A complete eye examination, including a dilated fundus examination, should be performed at the initial evaluation of the patient with a suspicious conjunctival lesion. Palpation for lymphadenopathy in the neck and preauricular region is an important part of the examination of tumor patients— especially those in whom a malignant lesion is suspected—because malignant lesions, especially conjunctival melanoma, can spread to regional lymph nodes. The clinical characteristics of the lesion