# A Case Report and an Overview of the Differential Diagnosis of Pigmented Lesions of the Conjunctiva: Just a Freckle or Something to Heckle?

## TL;DR

This paper presents a case of pigmented conjunctival lesions and discusses the challenges in distinguishing benign from potentially malignant conditions.

## Contribution

The paper contributes a case report and emphasizes the importance of thorough evaluation in diagnosing conjunctival pigmentation.

## Key findings

- The patient had pigmented conjunctival lesions diagnosed as benign melanosis.
- Comprehensive clinical history and multidisciplinary evaluation are essential for accurate diagnosis.
- Misdiagnosis of melanoma remains a concern due to the wide differential diagnosis of conjunctival pigmentation.

## Abstract

A 42-year-old darkly pigmented woman presented at our emergency department with complaints of pruritus, foreign body sensation, and blurry vision. Besides findings compatible with mild dry eye disease, anterior segment examination revealed dark pigmented, ill-defined areas of the conjunctiva surrounding the temporal limbus and temporal bulbar conjunctiva in the left eye and involving the superior and inferior tarsal conjunctiva in both eyes. The patient reported no recent changes in these lesions. A diagnosis of complexion-associated melanosis in the palpebral conjunctiva of both eyes and primary acquired melanosis in the bulbar conjunctiva of the left eye was assumed, and the patient was placed under regular follow-up. Preservative-free tears were also recommended for her dry eye condition.

Conjunctival pigmented lesions are a common finding during ophthalmologic evaluations. They pose a significant diagnostic challenge due to the wide array of differential diagnoses and the concern of misdiagnosing melanoma. A comprehensive clinical history and multidisciplinary evaluation are crucial in managing these cases.