Multifocal Blue Nevus of the Conjunctiva

Blue nevus is a congenital benign melanocytic tumor that classically occurs in the skin and carries low potential for malignant transformation. We report an unusual case of widely dispersed multifocal common blue nevus of the conjunctiva simulating conjunctival melanoma. A 55-year-old Hispanic woman was found to have multiple darkly pigmented lesions on her left eye. Excisional biopsy and adjuvant cryotherapy were performed. Histopathology revealed six pigmented foci within the substantia propria composed of spindle-shaped cells with a wavy dendritiform configuration consistent with common blue nevus. One lesion had associated racial melanosis and no lesion showed junctional activity or melanoma. In conclusion, conjunctival blue nevus can be multifocal and masquerade as melanoma.