Seborrheic keratosis of the conjunctiva: a case report

Seborrheic Keratosis (SK) is a benign neoplasm of the epithelium that occurs commonly on the eyelid skin. It is rarely found on the conjunctiva. We report a case of a 71 year old HIV positive man who presented with a pigmented conjunctival growth in his right eye. A working diagnosis of a pigmented Ocular Surface Squamous Neoplasia (OSSN) with malignant melanoma as a differential was made and an excisional biopsy done. The histology showed acanthotic epithelium with areas of pseudo-horn cysts, keratin pearls and squamous eddies. A histological diagnosis of seborrheic keratosis of the conjunctiva was made. Conjunctival Seborrheic Keratosis is extremely rare and the pigmentation makes it easily confused clinically with malignant melanoma or pigmented OSSN in the setting of HIV.