Choi and Chevez-Barrios reported histologic criteria for the diagnosis of inflamed conjunctival nevus (ICN). These criteria can help to distinguish this lesion from malignant melanoma and lymphoma. The authors are from Methodist Hospital in Houston and Weill Cornell Medical College in New York City.
Reasons that may cause initial concern:
(1) rapid growth
(2) nevomelanocytic proliferation with reverse maturation
Histologic features of ICN:
(1) nevomelanocytic cell proliferation within the epithelium and stroma lacking cytological atypia (lack marked nuclear pleomorphism, hyperchromasia, nucleoli and mitotic activity)
(2) lymphoplasmocytic inflammatory infiltrate with eosinophils
(3) solid and cystic epithelial components
(4) goblet cells associated with cystic epithelium (seen on PAS stain)
Lymphocytes are polyclonal. There may be increased IgG4 positive lymphocytes, especially in older adults.
Differential diagnosis:
(1) malignant melanoma
(2) malignant lymphoma
ICN has a good prognosis after complete excision.
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