Conjunctival nevi are melanocytic lesions that can be congenital and occur within the 6 months of life, or acquired and appear within the first two decades of life. These lesions are usually benign and malignant transformation is rare. For these lesions, close monitoring with photography by an expert ophthalmologist is recommended. Diagnosis is made by slit-lamp examination and sometimes pathology and biopsy (18–20). Even the incidence rate of growing malignant melanoma on preexisting conjunctival nevi is rare but, the patients usually prefer surgical removal. Cosmetic reasons are the first and most common reason for nevi removal surgery based on different studies. Ocular surface irritation was another reason for surgical options according to the patients (21). Similar to other studies, cosmetic reasons have caused our patient low self-esteem due to the nevus appearance, therefore; surgical option was his preferable choice (22).
Surgical intervention is necessary when the lesion is growing or its color is changing. The only way to discover the pathology is surgical removal followed by biopsy results. One of the surgical techniques is a full-thickness excision with a surgical microscope under general anesthesia. In this procedure, the nevus is removed along with a healthy margin and then closed with Vicryl 8-0 suture strings. Conjunctival edema, congestion, conjunctival hypertrophy, and also scaring were the post-surgery complications (23).
Another surgical option in large conjunctival nevi removal is using AMT to reconstruct the site of surgery after conjunctival resection. There are several advantages to using an amniotic membrane (AM). They are rich sources of stem cells that can help conjunctival epithelialization and healing process, maintain a normal conjunctival cosmetic appearance, and also reduce inflammation, immune rejection, vascularization, scarring, and pain after the surgery (24, 25).
Argon laser photoablation of conjunctival nevi is a safe, inexpensive, and fast alternative to surgery. This method is used especially when classical surgery is impossible due to the large size of the nevus. Argon laser ablation is a simple procedure without intraoperative hemorrhage. The recurrence rate is lower than the classical surgery. Against its simplicity, argon laser can destroy a primary malignant lesion without the ability to do histopathology testing for definite diagnosis (26–28). Post-operative inflammation, choroidal and ciliary body detachment, and subretinal neovascularization are other complications following argon laser ablation (29–31).
Pattern Scan Laser (PASCAL) photocoagulation is an alternative method for conjunctival nevi removal. In this method, collateral injuries were reduced due to the pulse duration reduction. Reduction in ocular pain during the procedure was another advantage of this method rather than argon laser ablation. After long-term follow-ups, there was no sign of recurrence or scaring. Similar to argon laser ablation, the PASCAL method also cannot have the histopathological confirmation of the tissue (32).
Recently, plasma radiofrequency ablation has been used to remove various nevi in different parts of the body such as skin and around the eye and its safety has been discovered (33, 34). Based on our previous studies on the PANIS method and its efficacy, it has shown that this method can be a minimally invasive technique for various ocular surface disorders (10–15). Therefore; in this case report, we are presenting a new approach for conjunctival nevus ablation using the PANIS method with AMT in a young adult. We did not use any fibrin glue or suture strings in this procedure and plasma spots were used for cutting, sublimating, and also fusing the AM to the conjunctiva. There was no sign of recurrence in 1 year of follow-up and the patient’s OSDI was reduced after the surgery.