It is not uncommon in clinical practice for an ophthalmologist to identify, during routine examination, unilateral or bilateral areas of flat stippled pigmentation in the bulbar or palpebral conjunctiva in middle aged or elderly patients. The pigmentation can have been unrecognised for many years and be static but in a minority of cases the process may progress to malignant melanoma. Thus, any pigmented lesion which is increasing in size should be given serious consideration and tissues should be submitted to an experienced pathologist in the form of an excision biopsy.

The simplest form of conjunctival pigmentation is the result of hypertrophy and hyperplasia of the basal cell layer of the epithelium which becomes packed with melanosomes. In this histological pattern, the nuclei of the melanocytes do not show variations in size and shape and do not …