{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T05:04:45Z","timestamp":1783919085075,"version":"3.55.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Ophthalmol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Lacrimal caruncular tumors are rare and exhibit a diversity of possible histopathological types. The majority of caruncular tumors are benign, followed by premalignant and malignant lesions, which are associated with a poorer prognosis. Clinical diagnosis is challenging. Therefore, a tissue biopsy is considered and performed based on the presence of features suggesting malignant or undetermined tumors for a definite diagnosis and proper management. The coexistence of different types of benign caruncular tumors is extremely rare and has been rarely described.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We herein describe the case of a 63-year-old Thai woman with a history of chronic progressive painless visual loss in her right eye who reported a non-progressive painless hyperpigmented mass without a history of associated contact bleeding on her left lacrimal caruncle. Ophthalmic examination revealed a large hyperpigmented choroidal mass with adjacent exudative retinal detachment in her right eye and a papilliform pinkish lesion over a well-defined, homogeneous, hyperpigmented mass on her left caruncle. Magnetic resonance imaging (MRI) scans of the orbit indicated a malignant choroidal melanoma in her right eye. The regional and distant metastatic work-ups were unremarkable. The patient was treated with a right globe enucleation concurrent with complete tumor removal of the left caruncular mass based on the presence of intratumorally dilated vessels with a feeding vessel to the overlying papilliform lesion, raising suspicion of malignancy, using the no-touch technique, followed by double freeze\u2013thaw cryotherapy. Histopathological examination disclosed a choroidal melanoma in the right eye and a subepithelial caruncular nevus with an overlying conjunctival papilloma emerging from the conjunctival epithelium of the nevus in the left eye. The patient made a complete recovery with no evidence of recurrence at the 12-month follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Coexistence of benign caruncular tumors is extremely rare. We report a rare case of a subepithelial nevus combined with a papilloma at the lacrimal caruncle. Complete tumor resection using the no-touch technique is the primary treatment. Adjunctive double freeze\u2013thaw cryotherapy may be considered to further prevent tumor cell seeding and postoperative recurrences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fopht.2026.1766863","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T04:23:04Z","timestamp":1783916584000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Subepithelial nevus and papilloma of the lacrimal caruncle: a case report and literature review"],"prefix":"10.3389","volume":"6","author":[{"given":"Siriphat","family":"Daocharoenporn","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University","place":["Bangkok, Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weerawan","family":"Chokthaweesak","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University","place":["Bangkok, Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chawawat","family":"Kangwanwongpaisan","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University","place":["Bangkok, Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siroratt","family":"Narkcham","sequence":"additional","affiliation":[{"name":"Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University","place":["Bangkok, Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bunyada","family":"Putthirangsiwong","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University","place":["Bangkok, Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1097\/00002341-199911000-00008","article-title":"An anatomic and histologic study of the caruncle","volume":"15","author":"Kathuria","year":"1999","journal-title":"Ophthalmic Plast Reconstr Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1016\/j.ajo.2009.09.028","article-title":"Non-syndromic supernumerary caruncles causing ocular irritation after cataract surgery: a critical review of caruncular dysgeneses","volume":"149","author":"Jakobiec","year":"2010","journal-title":"Am J Ophthalmol"},{"key":"B3","article-title":"The conjunctiva: anatomy and physiology","volume-title":"Cornea","author":"Hou","year":"2022"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/s00417-021-05464-x","article-title":"Clinico-pathological correlation of lacrimal caruncle tumors: a retrospective analysis over 22 years at the University Eye Hospital Bonn","volume":"260","author":"Clemens","year":"2022","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2006.04.035","article-title":"Tumors of the caruncle: a clinicopathologic correlation","volume":"142","author":"Kaeser","year":"2006","journal-title":"Am J Ophthalmol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1038\/eye.2008.316","article-title":"Lesions of the caruncle: a description of 42 cases and a review of the literature","volume":"23","author":"Levy","year":"2009","journal-title":"Eye (Lond)"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/0039-6257(78)90155-8","article-title":"Lesions of the caruncle: a clinicohistopathologic study","volume":"23","author":"Luthra","year":"1978","journal-title":"Surv Ophthalmol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/s0161-6420(94)31233-4","article-title":"Lesions of the lacrimal caruncle. 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