Posters

Squamous cell carcinoma of the conjunctiva and atopic disease: brief history of a troubled marriage

Poster Details

First Author: F.Huelin SPAIN

Co Author(s): C. Ginés-Gallego   D. Mingo-Botín                 

Abstract Details

Purpose:

Although frequently underdiagnosed, ocular surface squamous neoplasia is the most commonly observed malignancy of the conjunctiva. It encompasses a wide spectrum of diseases, ranging from mild epithelial dysplasia to invasive squamous cell carcinoma (SCC), being the last one a rare entity. Complete removal with no recurrences could be challenging in severe cases. When associated with atopic disease it can turn into a devastating condition. Limited reports have pointed out this connection, therefore further evidence is needed. Here we report our experience in the treatment of a SCC in an atopic patient by surgical excision associated with cryotherapy and adjuvant chemotherapy.

Setting:

Clinical evaluations, diagnosis, treatment and further follow-up of this clinical case was made at the Cornea and Ocular Surface Department of Hospital Universitario Ramón y Cajal, Madrid, Spain.

Methods:

A 38-year old man with persistent red eye and atopic dermatitis is referred to our center. A wide leukoplakic raised lesion in his inferior third of bulbar conjunctiva could be appreciated. It had first been noted by the patient 9 months ago. Treatment with mitomycin-C was previously attempted in another hospital without improvement in the abscence of histopathological confirmation. Biopsy of the lesion was performed with diagnosis of infiltrating SCC arising from in situ carcinoma with no adjacent structures invasion besides sclera. Other risk factors such as HIV infection were excluded. Conjunctival biopsy of the fellow eye showed normal histology.

Results:

Topical therapy with interferon alfa-2b was initiated with no clinical response. Hence, surgical excision of the entire lesion was performed with a tumor-free margin of 3-4 mm, followed by contiguous cryotherapy along the resulting surgical bed margins. Amniotic membrane graft was used to cover the remaining defect after surgery. Histopathological examination confirmed the presence of positive resection margins. Therefore, subsequent topical therapy with 5-fluorouracil was started at weekly on/off intervals. A total of four cycles of treatment were completed. Afterwards a new conjunctival biopsy confirmed that the patient remains disease-free 5 months after surgery solely treated with artificial tears.

Conclusions:

Combining medical and surgical approaches for the treatment of SCC of large size and infiltrating nature is frequently necessary in order to induce complete remission at long-term. Topical medications include mitomycin-C, 5-fluorouracil and interferon alfa-2b, although its role in invasive SCC remains uncertain. Previous reports have underscored the ominous prognosis in cases associated with atopic disease or immunosuppression. Hence, in our case it was mandatory to rule out bilateral disease and it made treatment with topical medications inadequate. Despite remaining free of disease at last visit, there is a high risk of later recurrence, so close follow-up is warranted.

Financial Disclosure:

None