Conjunctival and Iridic “Freckles”

The mother of a 5-year-old girl who was frightened by the appearance of a flat “freckle” in her daughter’s eye (A) was reassured by the diagnosis of a benign conjunctival nevus.

This type of nevus is usually not present at birth and develops by age 10 in nearly 50% of the patients who will have them. About 30% of these nevi are nonpigmented. They are located close to the limbus, resemble pingueculae, and have melanocytic nevus cells within the epithelial layer.

Other benign ocular lesions found in children that are not precursors of malignancy include compound and subepithelial types of conjunctival nevi, congenital lentiginous spots, melanosis oculi, and oculodermal melanosis.

In a different patient, the 2 yellowish tan to deep chocolate-brown freckles in the inferior portion of the iris are typical of benign lesions that are found in about 50% of adults (B). This patient is a 25-year-old woman.

These spots do not arise before ages 6 to 8 and are very uncommon before age 12. Conjunctival and iridic freckles rarely undergo malignant change. Reassurance is the only treatment necessary. However, suspect melanoma if long-existing nevi undergo sudden, active growth.