Case Number : Case 1974 - 22 Dec 2017 Posted By: Dr. Richard Carr

Subepithelial conjunctival nevus?

That was my first impression too: some kind of melanocytic lesion of the conjunctiva. But upon close inspection of the epithelial lining, I thought I saw umbrella cells on top and I don't really appreciate goblet cells in the lining as commonly seen in the conjunctiva. So I would suggest a melanocytic lesion of the urethra or ureter as an alternative.

As what the melanocytic lesion represents, it is very difficult just tonmake the diagnosis on these figures. I do not see any melanoma in situ component in the epithelium. The nodule of melanocytes is quite cellular and pigmented. I can't tell whether there are mitoses or not. The melanocytes are quite monotonous without clear cut maturation. If this is a conjunctival lesion, I do not see any epithelial cysts that we usually see in benign nevi. So I'm kind of worried that this could be a melanoma of the urethra? A cellular blue nevus also crossed my mind but I need to rule out melanoma first, particularly in this location. Clinical impression might help.

Agree with above. I was thinking of some association between urethral female caruncle and melanocytic pigmented nevus ( but maybe he is a men, who knows...)

Looks conjuntival, favour nevus

It's bladder and there is a history of ocular/retinal melanoma 3 years previously. Patient underwent cystoscopy for haematuria. We reported as most likely metastatic melanoma. Well done Anh!!

I've posted the answer to 1969 (last Friday's). Seasons greetings.

3 hours ago, Dr. Richard Carr said:

It's bladder and there is a history of ocular/retinal melanoma 3 years previously. Patient underwent cystoscopy for haematuria. We reported as most likely metastatic melanoma. Well done Anh!!

Thanks