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Photos courtesy of: Carol L. Shields, M.D. Used with permission. Not to be reproduced.

A 64-year-old white male presented with a reddish-looking mass on the conjunctiva which has been growing gradually for the past one year. Visual acuity was 20/30 in both eyes. The right eye was normal. The left eye lesion was as shown above.  Fundus was within normal limits.

1.	What is the most likely diagnosis?
	b. -- squamous cell carcinoma [? In situ]
2.	Treatment is
	c. -- excision of mass + Alcohol kerato-epitheliectomy + Cryotherapy of edges

The above case is classic ocular surface squamous neoplasia - the irregular gelatinous surface with prominent vessels entering the lesion. Excision of the mass, along with a margin of 1.5 – 2mm normal conjunctiva is done, which also confirms our diagnosis. Margins of the biopsy are sent separately to confirm any residual sub-clinical lesion. Cryotherapy to the residual conjunctival margin almost eliminates the chances of residual tumor and recurrence. Corneal component is scrapped off using alcohol.

REFERENCES:

1. Lee JA, Hirst LW. Ocular surface squamous neoplasia. Surv Ophthalmol 1995:39;
    429-450.

2. Shields CL, Shields JA, De Potter. Surgical approaches to conjunctival tumors. The
    1994 Lynn B. Mc Mahan lecture. Arch Ophthalmol 1997; 115: 808-815.