Aim To determine population-based incidence of conjunctival tumours in Olmsted County, Minnesota.
Methods The Rochester Epidemiology Project medical record linkage system was used to identify patients with conjunctival tumours in Olmsted County (1 January 1980 to 31 December 2015). Records were reviewed for demographics, types of tumours, histopathology, treatment and clinical course. Incidence rate of all tumours was calculated per 1 000 000 person-years. Poisson regression analysis was used to assess changes in incidence over time.
Results There were 504 patients with conjunctival tumours, giving an age-adjusted and sex-adjusted incidence rate of 125 per 1 000 000 (CI 113.5 to 135.5). Incidence increased over time (P<0.001). Most tumours (474, 94%) were benign. Of benign lesions, melanocytic lesions accounted for the majority (431, 86%), with adjusted incidence rates of 10.8 (CI 7.7 to 13.9) for complexion-associated melanosis, 49.7 (CI 42.9 to 56.6) for nevus and 44.1 (37.5–50.8) for primary acquired melanosis. Malignant lesions were rare (30, 6%) with 6 cases of melanoma, 21 cases of ocular surface squamous neoplasia (OSSN), 1 case of Langerhans cell histiocytosis and 2 cases of lymphoma. Adjusted incidence rates of conjunctival melanoma and OSSN were 1.5 (CI 0.3 to 2.8) and 6.1 (CI 3.5 to 8.7), respectively. Outcomes for melanoma (mean follow-up 14 years, range 0–34) and OSSN (mean follow-up 4 years, range 0–24) were favourable in 29 cases, with one fatality due to metastatic melanoma.
Conclusions In a population-based setting, most conjunctival tumours are benign, and the majority of lesions are melanocytic. While it is important to remain vigilant for malignancies, most conjunctival lesions in a community-based practice are not life-threatening.
- primary acquired melanosis
- ocular surface squamous neoplasia
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Contributors All authors contributed to the design, data acquisition and analysis of the study, and to the drafting and revision of the final manuscript.
Funding Supported in part by an unrestricted departmental grant from Research to Prevent Blindness, New York, NY, the Center for Clinical and Translational Science grant UL1TR000135, the REDCap Publishing Project, the Heed Ophthalmic Foundation (LAD), and Mayo Foundation. This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676.
Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Competing interests None declared.
Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.
Ethics approval This study complied with the Health Insurance Portability and Accountability Act and was approved by the Institutional Review Boards of Mayo Clinic and Olmsted Medical Center.
Provenance and peer review Not commissioned; externally peer reviewed.