Photo Credit: JodiJacobson

The following is a summary of “Primary acquired melanosis with spill over periocular lentigo maligna: 19-year outcomes at a specialist eyelid and ocular oncology centre,” published in the February 2025 issue of British Journal of Ophthalmology by Kanda et al. 

Researchers conducted a retrospective study to examine the presentation, management, and outcomes of primary acquired melanosis (PAM) with contiguous periocular lentigo maligna (LM) at an eyelid and ocular oncology specialist center.  

They reviewed consecutive cases of adults diagnosed with PAM and periocular LM from 2005 to 2024 at Moorfields Eye Hospital in London. Data on demographics, diagnosis, histology, imaging, treatment, surgical details, outcomes, and follow-up were extracted from the electronic patient records.  

The results showed that all 21 individuals were Caucasian, with 13 (62%) being women and an average diagnosis age of 67 years. The PAM atypia was mild in 5 (24%), moderate in 2 (9%), and severe in 14 (67%). Melanoma (all types) developed in 16 (76%), with 12 (57%) diagnosed with conjunctival melanoma. Among those with severe atypia, 93% progressed to melanoma. The average time from PAM and LM diagnosis to melanoma was 72 months. Melanoma recurrence occurred in 7 (44%), and metastases developed in 4 (25%), 4 individuals died, including 2 from metastatic melanoma. The average follow-up duration was 129 months.  

Investigators concluded that PAM with atypia, especially severe atypia and spillover periocular LM, carried a significant risk of melanoma progression, necessitating careful eyelid examination, multidisciplinary management, urgent biopsy (and confocal microscopy, if available), a lower threshold for treatment, and lifelong monitoring. 

Source: bjo.bmj.com/content/early/2025/02/17/bjo-2024-326691