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

Pemphigus. 

Not sure of significance of pigmentation however.  Possibly chronicity?

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

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

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

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.

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!

Sorry, naevus of Ota, not Ito.

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.

Ovoid