Successful management of large conjunctival squamous cell carcinoma with excisional biopsy, topical interferon, and amniotic membrane grafting: A case report.

INTRODUCTION AND IMPORTANCE: Conjunctival squamous cell carcinoma (SCC) is the most advanced form of ocular surface squamous neoplasia (OSSN), with varying incidence rates influenced by factors such as age, UV exposure, and occupation. Early detection is crucial, but misdiagnosis is common, especially when SCC mimics benign conditions like pterygium.

CASE PRESENTATION: An 83-year-old Caucasian male farmer presented with a rapidly enlarging nasal limbal lesion, initially misdiagnosed as pterygium. Clinical evaluation suggested malignancy, and an excisional biopsy using the "No Touch" technique was performed to avoid tumor seeding. Histopathology confirmed conjunctival SCC, with 10 % of the lesion remaining post-excision due to its large size. Adjuvant treatment with topical Interferon alpha-2a (1 MIU/cc) targeted the residual tumor. Amniotic membrane grafting was employed to manage the wound, and topical Mitomycin C was used to reduce the risk of recurrence. Follow-ups at 1 month, 3 months, 6 months, and 1 year showed no signs of recurrence.

DISCUSSION: This case underscores the importance of distinguishing conjunctival SCC from benign lesions. The combined approach of surgical excision, topical immunotherapy, and chemoprophylaxis was effective in treating this advanced SCC case, preventing tumor recurrence.

CONCLUSION: A multidisciplinary treatment strategy can effectively manage advanced conjunctival SCC, as seen in this case, where no recurrence occurred after one year of follow-up. Early detection and comprehensive care are essential for positive outcomes.