An 84-year-old woman had ...

An 84-year-old woman had a pigmented lesion in the left nasal canthus that had increased for five months. The lesion was discovered incidentally 14 months prior during a routine optometry assessment and had not changed in appearance except for its recent increase in size. The patient had no visual problems, eye pain, redness, foreign body sensation, or bleeding from the lesion. She had a history of cataract surgeries but no history of eye disease, trauma, malignancy, chemotherapy use, or exposure to industrial chemicals. Her medical conditions were well-controlled, and her family history was unremarkable. Visual acuity was good in both eyes, intraocular pressure was expected, and anterior segment examination showed a raised, homogenous, pigmented region. Dilated ophthalmoscopy showed no abnormalities. The decision was made to altogether remove the tumour due to its recent growth and unusual position. Excisional biopsy showed, in a 5 × 3 mm piece, a 5 mm proliferation of heavily pigmented melanocytes arranged at the epithelial-stromal junction and abundant melanin-laden macrophages in the underlying stroma with no evidence of pagetoid spread or dysplasia as shown in figure 1