Insights into Ocular Surface Squamous Neoplasia – A Case Study in Diagnosis and Management

We report a case of Ocular surface squamous neoplasia (OSSN) in a thirty-year-old female with Xeroderma pigmentosa who presented with complaints of pain, irritation, photophobia, foreign body sensation and a small mass, gradually increasing in size in the left eye. Examination revealed multiple diffuse mottled erythematous pigmentation over face suggestive of Xeroderma pigmentosa. On Slit lamp examination right eye was unremarkable with 6/6 vision whereas left eye with 6/12 vision showed a round, 1x1 cm lobulated, non-mobile, hard lesion with abnormal vasculature on nasal bulbar conjunctiva in interpalpebral area. CT orbit revealed a lobulated lesion involving infero-medial aspect of anterior surface of sclera showing contrast enhancement with no obvious deeper extensions and negative HIV test. She underwent excisional biopsy, followed by application of Mitomycin C and cryotherapy and later with an amniotic membrane graft on her left eye. Histopathological analysis revealed moderately differentiated invasive squamous cell carcinoma that extended into all horizontal and deep surgical margins. As a result, adjuvant treatment with topical interferon alpha 2B was initiated. At the 10-month postoperative visit, her visual acuity was 6/9, improving to 6/6 with a pinhole test, and no clinical evidence of recurrent squamous cell carcinoma was observed. Keywords: Conjunctiva, Ocular surface, Neoplasia, Mitomycin C, Xeroderma pigmentosa