Which malignant orbital tumor is associated with salmon patches in the conjunctiva?

• A. Rhabdomyosarcoma
• B. Neuroblastoma
• C. Cavernous hemangioma
• D. Lymphoma

Answer: (D)

A salmon-colored conjunctival patch is a classic sign of ocular/adnexal lymphoma, typically involving malignant lymphoid tissue such as extranodal marginal zone B-cell lymphoma. This patch is due to infiltration of the conjunctiva by lymphoid cells, giving a flat, pink-salmon appearance that can be painless and slowly progressive. In contrast, rhabdomyosarcoma tends to present as a rapidly enlarging, destructive orbital mass with proptosis; neuroblastoma metastasis often shows periorbital ecchymosis rather than a distinct conjunctival patch; cavernous hemangioma is a benign vascular tumor that usually appears as a well-circumscribed, slowly growing mass rather than a flat patch. The salmon patch thus points toward lymphoma in the orbit/conjunctiva.