Giachos, Ioannis; Thaung, Caroline; Ting, Darren Shu Jeng; (2024) Melanocytic ocular surface squamous neoplasia successfully managed with no-touch excisional biopsy, cryotherapy and amniotic membrane transplantation. Eye 10.1038/s41433-024-03069-2. (In press).

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Abstract

Ocular surface squamous neoplasia (OSSN) is the most common non-pigmented tumour of the ocular surface, with an estimated incidence of 0.03–3.4 per 100,000 people/year [1, 2]. Depending on the severity and patient/surgeon preference, it can be managed medically and/or surgically [2]. This case highlights a 79-year-old man with a delayed presentation of left melanocytic OSSN due to an initial misdiagnosed pterygium. Slit-lamp examination revealed a gelatinous, papilliform corneo-conjunctival lesion temporally, with surface leukoplakia/keratinisation (green arrow), feeder vessels (black arrows), and melanocytic pigment (yellow arrow; Fig. 1A, B). After an unsuccessful cycle of topical mitomycin-C 0.04%, a no-touch, wide-margin (4 mm) excisional biopsy coupled with 100% alcohol, double freeze-thaw cryotherapy, and amniotic membrane transplantation was performed [3]. Histopathological examination confirmed a grade 2–3 conjunctival intraepithelial neoplasia with epithelial thickening, focal dyskeratosis (blue arrows), non-neoplastic dendritic melanocytes (black arrows), and architectural/cytological atypia (Fig. 1C). No recurrence was noted over the subsequent 9 months (Fig. 1D).

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