Purpose: To report a case of pigmented caruncular oncocytoma that simulated malignant melanoma and discuss the associated ultrasonographic and pathologic features. Method: Case report. Results: An 81-year-old female presented with a painless caruncular mass with a smooth brown surface suspicious for melanoma. Ultrasound biomicroscopy revealed a round mass with a large central cavity, more suggestive of a cystic rather than solid lesion. Following complete surgical resection, histopathology revealed a cystadenomatous lesion composed of bland cells with copious eosinophilic cytoplasm consistent with oncocytoma that had a central blood-filled cavity. Conclusions: Oncocytoma is a benign tumor that can appear pigmented clinically and resemble melanoma. The definitive diagnosis requires histopathologic evaluation. Oncocytoma should be considered in the differential diagnosis of a pigmented caruncular mass.

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Shields CL, Shields JA, Arbizo V, Augsburger JJ: Oncocytoma of the caruncle. Am J Ophthalmol 1986;102:315-319.
Rennie IG: Oncocytoma (oxyphil adenomas) of the lacrimal caruncle. Br J Ophthalmol 1980;64:935-939.
Ostergaard J, Prause JU, Heegaard S: Oncocytic lesions of the ophthalmic region: a clinicopathological study with emphasis on cytokeratin expression. Acta Ophthalmol (Copenh) 2011;89:263-267.
George E, Swanson PE, Newman BK, Wick MR: Oculocutaneous oncocytic tumors: clinicopathologic and immunohistochemical study of 2 cases with literature review. Am J Dermatopathol 2007;29:279-285.
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Di Nicola M, Miserocchi E, Rizzo N, Grantoza CL, Bandello F, Modorati G: Atypical presentation of a pigmented oncocytoma of the caruncle: a case report. Case Rep Ophthalmol 2013;4:16-19.
Shields CL, Shields JA, Gündüz K, Cater J, Mercado GV, Gross N, et al: Conjunctival melanoma: risk factors for recurrence, exenteration, metastasis, and death in 150 consecutive patients. Arch Ophthalmol 2000;118:1497-1507.
Uysal Y, Shields CL, Mashayekhi A, Shields JA, Eagle RC Jr: Ultrasound biomicroscopy of cystic and solid caruncular oncocytoma. Arch Ophthalmol 2006;124:1650.
Zhang J, Demirci H, Shields CL, Leon JA, Shields JA, Eagle RC Jr: Cavitary melanoma of ciliary body simulating a cyst. Arch Ophthalmol 2005;123:569-571.
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Demirci H, Vine AK, Elner VM: Choroidal metastasis from submandibular salivary gland adenoid cystic carcinoma. Ophthalmic Surg Lasers Imaging 2008;39:57-59.
Veronese C, Pichi F, Guidi SG, Shields CL, Ciardella A: Cystoid changes within astrocytic hamartomas of the retina in tuberous sclerosis. Retin Cases Brief Rep 2011;5:113-116.
Shields JA, Shields CL: Eyelids cystic lesions simulating neoplasms; in: Shields JA, Shields CL: Eyelid, Conjunctival, and Orbital Tumors: An Atlas and Textbook, ed 3. Philadelphia: Lippincott Williams and Wilkins 2015, pp 195-205.
Hayashi Y, Watanabe T, Kita D, Hayashi Y, Takahira M, Hamada J: Orbital cystic schwannoma originating from the frontal nerve. Case Rep Ophthalmol Med 2012;2012:604574.
Fetkenhour DR, Shields CL, Chao AN, Shields JA, Guterman CB, Eagle RC Jr: Orbital cavitary rhabdomyosarcoma masquerading as lymphangioma. Arch Ophthalmol 2001;119:1208-1210.
Shields JA, Shields CL, Eagle RCJ, De Potter P, Oliver GL: Necrotic orbital melanoma arising de novo. Br J Ophthalmol 1993;77:187-189.
Kapil JP, Proia AD, Puri PK: Lesions of the lacrimal caruncle with an emphasis on oncocytoma. Am J Dermatopathol 2011;33:227-235.
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