Criteria for Management of Melanosis

To the Editor: Your Feature Photo captioned "Cancerous Melanosis" in the March issue followed by your editorial "Primum non nocere" in the April issue have prompted me to take up the pen. The editorial quite properly suggests that ophthalmic surgeons, along with many other physicians fighting cancer, have been guilty of excessive surgery. The two lesions specifically cited as examples of pseudocancerous conditions leading to unnecessary concern and to radical operations were nodular fasciitis and keratoacanthoma. While I agree that these lesions are sometimes treated more vigorously than is necessary, I doubt that very many exenterations have been done for them. On the other hand, I know that many have been performed after a diagnosis of cancerous melanosis has been made. A genuine malignant melanoma arising in an area of acquired melanosis of the conjunctiva carries a poor prognosis, and I will not quarrel here with those who believe that