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case_images: Initial slit-lamp examination of the left eye. Diffuse disseminated pigmentation in the conjunctiva can be seen around the cornea.
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case_images: Slit-lamp examinations showed that the conjunctiva of the right eye was normal but diffuse disseminated pigmentation was detected around the cornea of the left eye (Figure 1).
case_images: Rapid histopathological analysis of initial biopsy. There was no excess melanocyte proliferation in the epithelial layers. Thus, it was diagnosed as primary acquired melanosis (PAM) with reactive lymphoid hyperplasia and without atypia (A: low magnification, B; high magnification).
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case_images: Histopathological analysis by frozen section suggested PAM with subepithelial reactive lymphoid hyperplasia, as there was no melanocytic nests or obvious cellular atypia and pigmentation (Figure 2).
case_images: Seven years after excisional biopsy. No change was observed on the pigmentation in the conjunctiva.
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case_images: She was followed for 7 years after the biopsy and no changes were observed (Figure 3).
case_images: Fourteen years after the excisional biopsy. Black tumor expanding from the fornix and disseminated pigments at bulbar and palpebral conjunctiva can be seen.
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case_images: Our examination showed that her BCVA was the same; however, a black tumor that extended from the fornix and disseminated pigments at the bulbar and palpebral conjunctiva were detected in her left eye (Figure 4).
case_images: Histopathological specimen of the conjunctival tumor (H&E staining). Tumor was a conjunctival malignant melanoma.
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case_images: Hospital. Histopathological analysis revealed that the tumor was a conjunctival malignant melanoma (Figure 5) but no metastasis was found by a general check-up and her postoperative course was good.