Primary Acquired Melanosis (PAM)

• Typically develops in middle-aged or elderly white patients.

Clinical Features

• Almost always unilateral
• Uni- or multifocal, flat, indistinct areas of conjunctival pigmentation
• Commonly involves the inferior or superior fornices
• May remain stable over years, become smaller, undergo color changes or malignant transformation
• Work up: multiple biopsies are sometimes required to define the cytological status of the lesions.

Management

• Regular follow-up with photographic documentation.
• Local excision with or without extensive cryotherapy should be performed if the lesion becomes thicker and demonstrates invasive nodular formation.