Invasive conjunctival melanoma with associated conjunctival intraepithelial melanocytic lesion (C-MIL) in an Afro-Latino male: a case report

Abstract Background Conjunctival melanoma is a rare, potentially life-threatening ocular malignancy with risk of local recurrence and metastatic spread. It is uncommon in Black and other darkly pigmented populations and may be clinically underrecognized or misattributed to benign conjunctival pigmentation. Many cases arise in association with an intraepithelial precursor lesion, historically termed primary acquired melanosis (PAM) with atypia and now classified within the spectrum of conjunctival intraepithelial melanocytic lesions (C-MIL). Case presentation A 36-year-old Afro-Latino male presented with a progressively enlarging, irregularly pigmented temporal limbal lesion with corneal extension and a prominent feeder vessel. He underwent wide excision using a “no-touch” approach with alcohol epitheliectomy, cryotherapy, and intraoperative mitomycin-C. Histopathology demonstrated invasive conjunctival melanoma arising from an intraepithelial melanocytic lesion consistent with C-MIL/PAM with atypia. Immunohistochemistry (HMB45 and SOX10) highlighted melanocytic tumor cells, with increased Ki-67 proliferative activity. The tumor measured 1.6 mm in maximal depth (AJCC pT1a). At three months, the ocular surface was re-epithelialized without clinical evidence of recurrence; the patient remains under close surveillance. Conclusions This case underscores the importance of maintaining a high index of suspicion for conjunctival melanoma in patients presenting with evolving pigmented conjunctival lesions, including those with darker skin pigmentation. Early recognition, prompt surgical excision, and histopathologic confirmation are critical to optimizing outcomes. This report contributes to the limited literature on conjunctival melanoma presentations in underrepresented populations and reinforces the need for vigilant long-term surveillance given the tumor’s malignant potential.