Basal cell carcinoma (BCC) is a common eyelid skin tumour that can arise very rarely from the conjunctiva.• The pigmented variant of BCC accounts for 6% of skin BCCs but has never been reported in the conjunctiva. Novel Insights• This is the first report of a pigmented BCC of the conjunctiva, mimicking a conjunctival melanoma.• The pigmented BCC showed prominent melanocyte hyperplasia, melanophages and tumour cell cytoplasmic melanin. • Pigmented BCC should be considered in the differential diagnosis of pigmented, non-melanocytic tumours of the conjunctiva. AbstractA 60-year-old, South-Asian male patient presented with a dark brown lesion on his left conjunctiva surface near the limbus for 2 years. Examination showed a globular, dark brown-coloured mass near the temporal limbus at 4 to 5 o'clock position, measuring 3 × 3 × 2 mm. There were a few scattered flat pigmented lesions near the mass and also a few prominent vessels. The mass underwent wide local excision, with a clear margin, followed by double freeze cryotherapy of the conjunctival margins along with the application of Mitomycin C. The bare sclera was covered by amniotic membrane. Histology surprisingly revealed a nodular basal cell carcinoma (BCC) containing melanin. The melanin was present in the tumour cell cytoplasm, within melanophages and within dendritic, Melan A-positive melanocytes. The BCC was immunohistochemically positive for BerEP4 and negative for EMA. The clinically observed smaller nodules flanking the main pigmented BCC corresponded histologically to pigmented superficial growth pattern BCC connected to the under surface of the conjunctival epithelium. This is the first report of a pigmented BCC of the conjunctiva, mimicking a conjunctival melanoma. Pigmented BCC should be considered in the differential diagnosis of pigmented tumours of the conjunctiva.

The potentially fatal infectious disease "Melioidosis", caused by the saprophyte Burkholderia pseudomallei, has remained in the shadows for far too long. Although, the bacterium has been described almost a century ago in Myanmar, and considerable progress in terms of diagnosis and treatment was achieved, B.pseudomallei is still "the unbeatable foe", for several reasons like under-recognition, high case-fatality rate, unacceptable relapse rate and a "time-bomb" effect for sero-positive individuals. Just like Mycobacterium tuberculosis, the organism can remain latent for decades before the onset of clinical signs and symptoms. The first case of melioidosis from Bangladesh was reported in 1964, in a 29 year old British sailor who was travelling through Bangladesh. Since then, around 68 culture proven melioidosis cases have been sporadically detected in Bangladesh over last several decades. However, the true melioidosis burden is unknown in this region due to lack of awareness and absence of systematic surveillance and research. The reasons for its under-recognition are unavailability of diagnostic microbiology laboratories serving the rural poor in the tropics, who are most likely to acquire melioidosis, and a lack of familiarity and awareness amongst medical and laboratory staff, where such laboratories are available. Clinical diagnosis is exceptionally challenging due to the varied clinical presentations, as the disease can mimic other infections. The most striking reason for this unawareness is that, melioidosis is still considered as one of the most neglected tropical diseases (NTDs), so much so that it is not even included in the WHO list of NTDs. The burden of melioidosis reveals the gaps in dealing with the disease, whereas the prevention mechanism clearly demands public health action in Bangladesh. Without early diagnosis and treatment and exploring better ways to prevent transmission, melioidosis will spread exponentially and claim more lives in the year to come. Therefore, clinicians and microbiologists should be made aware about this pathogen and its frequent misdiagnosis. Availability of validated diagnostic reagents for immunological and molecular tests and expansion of databases of commercial identification systems will likely remove the major hurdles in correct identification of B. pseudomallei. In conclusion, a high level of suspicion on the part of clinicians along with vigilant microbiologists and availability of discerning diagnostic assays may help in identification, reporting, and subsequent management of this "mimicker of maladies".

A 36-year-old male patient presented with a firm swelling in the left lacrimal sac region with a history of recurrent episodes of acute dacryocystitis, which partly resolved with systemic antibiotics. Computed tomography showed diffuse soft tissue mass without bony erosion in the same area. Incisional biopsy confirmed diffuse large cell lymphoma of non-Hodgkin's type by histopathology and immunohistochemistry. Oncologists did not detect systemic involvement, and the patient received six cycles of cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisolone (CHOP). Epiphora was resolved, and no recurrence of the lesion was seen with subsequent dacryocystorhinostomy with intubation and was in good health for up to 3 years of follow-up. Although primary lacrimal sac lymphoma is a rare entity, high suspicion, and prompt action in atypical cases can save lives from aggressive diffuse large cell lymphoma.

Ocular surface squamous neoplasia (OSSN) is the most common nonpigmented ocular surface neoplasm. Interferon-alpha (IFNα)-2b has been proved to be an effective immunotherapeutic agent to treat OSSN. We have used intralesional and topical (36 μg/ml) pegylated (peg) IFNα-2a to treat a recurrent surgically failed case of OSSN instead of IFNα-2b. In this case report, we have shared our initial experience with the novel use of peg-IFNα-2a to treat OSSN. According to our brief clinical experience, peg-IFNα-2a is nontoxic to ocular surface and has a promising role to treat OSSN.

To report the management of a case presented with recurrent extensive conjunctival papillomatous neoplasia. Case Report: A 2 year old girl presented with left recurrent extensive conjunctival squamous papilloma being treated surgically thrice along with adjunctive cryotherapy and topical Mitomycin C (MMC). We managed the case with surgical excision again with adjunctive subconjunctival or sublesional pegylated (peg) interferon alpha 2a injection along with the whole surface amniotic membrane graft. The patient had upper canalicular papillomatous lesion which was also managed by surgical excision and subcanalicular peg-interferon alpha 2a injection. There was no recurrence in subsequent 3 months follow up. Conclusion: Subconjunctival pegylated interferon alpha 2a injection and amniotic membrane graft may be a novel combined modality to manage extensive conjunctival squamous papillomatous neoplasia that may yield successful outcome.