Conjunctival Squamous-Cell Carcinoma after Kidney Transplant

Introduction: Conjunctival squamous cell cancer (SCC ) is rare affecting HIV patients and elderly exposed to extra UV light, the incidence increases post kidney transplant due to immunosuppression, treatemnt with wide excision,cryotherapy, local chemotherapy and radiation had been successful Prognosis depends on local invasion of the tumor to the orbit and the presence of distal metastasis.Our patient developed SCC 13 years post transplant Case Description: 64 year old Hispanic male farm worker diagnosed with Hypertensive Nephrosclerosis on Hemodialysis received a kidney transplant in 2011 baseline creatinine 1mg/dl was maintained on Tacrolimus 2 mg bid imuran 50 mg as he did not tolerate Mycophenolate Mofetil and prednisone 5 mg . Presented in 2/24 with a right eye mass, tearing and eye discharge, followed by headach (figure 1) Orbital and head MRI showed fungating mass involving the temporal conjunctiva without invasion to the cornea . Biopsy of the lesion showed SCC. He underwent excision/debulking of the mass and pathology confirmed SCC with positive margins, Oncology consult suggested cryotherapy,local chemotherapy or radiation therapy The patient agreed to local chemptherapy with eye drops . Immunosuppression had been reduced with discontinuing imuran and lowering tacrolimus to a level of 3-5 with 5 mg prednisone. Discussion: The risk of SCC increases with the duration of immunosuppression, 7% of transplant patients develop SCC after 10 years and 35% after 25 years ,conjuctival SCC is rare with incidence of 0.02-2.8/100000, It usually grows slowly on the epithelial surface of the eye and rarely invades the orbit and spreads distally, treatment is wide excision of the conjunctive with reconstructive flaps, cryotherapy, topical chemotherapeutic eye drops like mytomycin ,5FU and interferon, prognosis is not bad if dicovered early,5 years survival 85%.