PAM testing findings on an A-seg photo typically show which of the following?

• A. Flat, brown lesion with no cysts
• B. Gelatinous, elevated lesion with vascularization
• C. Red conjunctival lesion with discharge
• D. White scleral patch

Answer: (A)

Primary Acquired Melanosis presents on the conjunctiva as a flat, pigmented brown patch. On an A-seg photo you would look for a flat lesion without surface cysts. The lack of cysts helps distinguish PAM from a conjunctival nevus, which often shows epithelial cysts within the lesion. Other described findings like an elevated gelatinous lesion with vascularization, red conjunctival discharge, or a white scleral patch point to inflammatory, vascular, or scar processes rather than PAM. PAM is important to recognize because if there is atypia, it carries a risk of progression to melanoma, so monitoring and possible biopsy are warranted.