Abstract
Purpose: This study was conducted to show diverse clinical presentation of ocular surface squamous neoplasia with a rare presentation of caruncle squamous cell carcinoma (SCC).
 Methods: All cases that had suspicious ocular lesion were included in the treatment study. A detailed history including demographic data was obtained. Clinical features regarding the type of lesion, location, and the involvement of cornea were evaluated. For all patients, excisional biopsy following “Shield’s no-touch technique” with 3 to 4 mm margins of uninvolved tissue and cryotherapy at excisional margins was done. All specimens were sent for a histopathological evaluation. Topical chemotherapy (mitomycin C, 0.02%) was used as an adjunctive therapy following surgical excision for large and diffuse ocular surface tumors. All patients were subjected to long-term regular follow-ups.
 Results: Twenty-six patients (18 men and 8 women) with a mean age of 54.2 years were enrolled in this study. The results showed that the most common localization was bulbar conjunctiva (92%). Nodular lesions (46.5%) and SCC (57.5%) were the most common clinical and histopathological features, respectively. We observed one rare case of primary SCC of the left caruncle in a 68-year-old man who had an asymptomatic medial canthal mass. Recurrence was found in two patients with SCC, one of them having an orbital extension.
 Conclusion: The early suspicion of ocular surface neoplasia will be accomplished with a simple excision in most cases, leading to a favorable outcome except in severe progressive cases.
Highlights
Ocular surface squamous neoplasia (OSSN) is a spectrum of pathology ranging from noninvasive intraepithelial dysplasia of the conjunctiva and cornea to invasive squamous cell carcinoma (SCC).[1]
We reported a rare case of primary squamous carcinoma of caruncle (Fig. 4), which was resected completely followed by the topical chemotherapy and showed total cure with no recurrence during a 20-month follow-up
OSSN has numerous clinical features, its most common presentation is a nodular type of lesion
Summary
Ocular surface squamous neoplasia (OSSN) is a spectrum of pathology ranging from noninvasive intraepithelial dysplasia of the conjunctiva and cornea to invasive squamous cell carcinoma (SCC).[1] The limbal stem cells are the origin of OSSN, which normally arise in the interpalpebral region and involved the bulbar conjunctiva, the cornea, or both structures.[2]. The presence of feeder vessels, intrinsic vascularity, and a nodular lesion raise suspicion of invasive SCC.[3]. Temporal and superior locations, lack of corneal involvement, and papillomatous and nodular appearance were associated with higher-grade OSSN lesions in a study in the United States.[4]. While histopathology is the gold standard in the diagnosis of OSSN, high-resolution optical coherence tomography can be used to noninvasively detect the presence of OSSN in patients with coexisting ocular conditions.[5]
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