Fathian Amirmohammad, Fazlinejad Navid, Attar Alireza
Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Int J Surg Case Rep. 2025 Feb;127:110820. doi: 10.1016/j.ijscr.2025.110820. Epub 2025 Jan 7.
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.
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.
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.
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.
结膜鳞状细胞癌（SCC）是眼表鳞状上皮肿瘤（OSSN）的最严重形式，其发病率受年龄、紫外线暴露和职业等因素影响而有所不同。早期检测至关重要，但误诊很常见，尤其是当SCC模仿翼状胬肉等良性疾病时。
一名83岁的白种男性农民，鼻侧角膜缘有一迅速增大的病变，最初被误诊为翼状胬肉。临床评估提示为恶性肿瘤，遂采用“无接触”技术进行切除活检以避免肿瘤播散。组织病理学确诊为结膜SCC，因其病变较大，切除后仍有10%的病变残留。采用局部注射干扰素α-2a（1 MIU/cc）辅助治疗残留肿瘤。采用羊膜移植处理伤口，并使用局部丝裂霉素C降低复发风险。1个月、3个月、6个月和1年的随访均未发现复发迹象。
该病例强调了区分结膜SCC与良性病变的重要性。手术切除、局部免疫治疗和化学预防相结合的方法有效地治疗了这例晚期SCC病例，防止了肿瘤复发。
如本病例所示，多学科治疗策略可有效管理晚期结膜SCC，随访一年未出现复发。早期检测和综合护理对于取得良好预后至关重要。
