Abstract
Conjunctival nevi (CN) present as variably pigmented, variably elevated, cystic-appearing lesions most frequently located in the nasal or temporal quadrant of the interpalpebral bulbar conjunctiva. They are benign and the most common conjunctival melanocytic lesion. The differential diagnosis of conjunctival melanocytic lesions includes primary acquired melanosis (PAM), complexion-associated melanosis (CAM), malignant melanoma (MM), and ocular melanocytosis. Features that can assist in differentiating CN from other pigmented lesions include long-time presence, a well-circumscribed appearance, and cysts dispersed within the pigment either on slit lamp examination or anterior segment optical coherence tomography. Management of CN is typically routine monitoring with clinical examination; however, the gold standard for diagnosis is excisional biopsy with histopathology. Although the risk of transformation to MM is extremely rare, any change in size or pigmentation during routine observation should raise suspicion for malignancy, in which case an excisional biopsy with histopathology should be conducted.