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Nevi are the most common pigmented conjunctival lesions and have a lower risk of malignant transformation than PAM (Figure 2).1 They are focal, often cystic, well-circumscribed, and interpalpebral, and are usually present from childhood.1 Change in size and appearance can occur during periods of hormonal changes, such as pregnancy and puberty.1 Early detection and timely management of conjunctival melanoma is crucial, as 20%30% metastasize (Figure 4).3 Whereas histopathology confirms diagnosis, clinical features warranting referral to ophthalmology for evaluation include unilaterality, recent onset, change in size or pigmentation, history of sun exposure, uncertain lesion history, or personal or family history of dermatologic malignancies.1 , 6 Ultraviolet (UV) radiation exposure increases the risk of conjunctival melanoma, which highlights the importance of sunglasses with UVA and UVB protection.7 Given the potential for malignant transformation and associated morbidity and mortality of conjunctival melanoma, early referral to an ophthalmologist is essential