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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 2769 - 16 February 2021 Posted By: Uma Sundram

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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59 year old female with pigmented lesion, right lower eyelid conjunctiva.


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Richard Logan

Posted

Pemphigus. 

Not sure of significance of pigmentation however.  Possibly chronicity?

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Dr. Richard Carr

Posted

PAM most likely, no atypia. Needs a Sox10 or melanA

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Leila Ahmed

Posted

Is the patient dark skinned? Could it be a benign melanosis? If fair skinned individual then PAM without atypia as suggested by Dr Carr.

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Richard Logan

Posted

I have betrayed my inexperience with interpreting conjunctival histology.  Is the surface disruption normal for conjunctival epithelium?

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Dr. Richard Carr

Posted

It's actually helpful to others to see your comments Richard as probably others will have similar ponderings. Yes looks normal pseudostratified conjunctival epithelium with scattered goblet cells. History is not good for pemphigus.

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Richard Logan

Posted

Thanks Richard. 

Yes the history doesn't suggest pemphigus, but then we are not always told the full story in this arena!

Might this appearance be compatible with a naevus of Ito with bulbar involvement?  I presented such a case to the RSM in the 1980's!

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Richard Logan

Posted

Sorry, naevus of Ota, not Ito.

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Uma Sundram

Posted

Hi everyone, I figured conjunctiva histology is something we can all learn from. It's hard to tell from the pictures, but there are some avoid melanocytes as well. We finally landed on combined nevus. I did need an expert's help, however.

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