A 66-year-old woman was treated with excision and cryotherapy for recurrent primary acquired melanosis (PAM) with atypia of the right conjunctiva. Four years later, she developed a melanoma of the ipsilateral inferior turbinate and nasolacrimal duct. She was treated with right medial maxillectomy and postoperative radiation therapy. This is the first reported case of conjunctival PAM resulting in delayed progression to melanoma in the nasolacrimal duct and sinonasal cavity.
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