Squamous Cell Carcinoma Of The Conjunctiva

Aka Ocular surface squamous neoplasia (OSSN): can also arise from corneal epithelium

Most common malignancy of the ocular surface

• More common >50 years old

• Risk factors

  • UV exposure
  • Human papilloma virus
  • HIV

• May arise from intraepithelial hyperplasia or de novo

  • Conjunctival intraepithelial neoplasia (CIN -carcinoma in situ)
  • Rare but more common over age 50
  • Fleshy freely mobile mass with tufted vessels
  • Often found at the limbus
  • May transform to SCC
  • Manage with excision, MMC +/- cryotherapy and further cycles of MMC/5-FU

Clinical features

• Persistent unilateral keratoconjunctivitis
• Appearance of atypical dysplastic epithelium
• Gelatinous limbal mass
• Rarely metastasizes

Management

• Conjunctival map biopsies may be needed to define extent
• Excision with 2-3mm clear margins
• Intraoperative MMC followed by 3 further cycles with MMC or 5-FU drops
• Cryotherapy to surgical margins
• Enucleation/exenteration for advanced invasive disease