Squamous Cell Carcinoma of the Conjunctiva in a Patient With Previous Squamous Cell Carcinoma of the Lower Lip

Abstract

Squamous cell carcinoma (SCC) of the conjunctiva is a rare malignancy that is part of the spectrum of ocular surface squamous neoplasia (OSSN). Numerous non-modifiable and modifiable risk factors, such as male sex, age, cigarette smoking, and immunosuppression, have been identified. Any lesion of the conjunctiva requires a differential diagnosis between benign and malignant diseases, and all suspicious lesions should be biopsied.We present a case of SCC of the conjunctiva in a former smoker with multiple risk factors, including a previous SCC of the lower lip. Metastatic tumors rarely occur in the conjunctiva, but due to our patient's medical history, the exclusion of metastasis from the previous primary tumor was performed through whole-body imaging restaging.The patient underwent a no-touch wide resection, followed by adjuvant topical chemotherapy with 5fluorouracil (5-FU). After finishing treatment, the patient continues to attend regular ophthalmology and oncology appointments.Increasing population awareness of modifiable risk factors for OSSN is essential. Misdiagnosis can lead to a loss of time in treatment and progression of the disease.

Intraocular Spread of Ocular Surface Squamous Neoplasia Presenting as a Postoperative Anterior Chamber Opacity after Excisional Biopsy

“…This case emphasizes the importance of taking surgical precaution when excising any conjunctival lesion, especially those which are atypical or have poor prognostic risk factors including large size and corneal involvement, as were features of this case. When excising a conjunctival lesion, the surgeon should pay special attention not to create a potential track for cells to enter the globe and also employ intraoperative cryotherapy to ensure clear surgical margins [14]. Most reported cases of intraocular invasion of OSSN have a history of prior excision of a limbal lesion which, as per Shields et al [11], should serve as a “clue” for the underlying diagnosis.…”