How is conjunctival squamous cell carcinoma (SCC) differentiated from conjunctival intraepithelial neoplasia?

Updated: Jul 08, 2020
  • Author: Talib Najjar, DMD, MDS, PhD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Distinguishing conjunctival SCC from conjunctival intraepithelial neoplasia is difficult on clinical examination alone. [39] Conjunctival SCC represents a type of conjunctival intraepithelial neoplasia that has either broken through the basement membrane to involve the subepithelial tissue or has metastasized. [40, 41, 42]

Given its variable appearance, conjunctival SCC may pose a diagnostic challenge as a masquerade syndrome. Patients with an atypical pterygium may have a conjunctival tumor and should be observed much more closely than patients with a classic pterygium. Unsuspected ocular surface neoplasia may be present within excised pterygia. For this reason, one study recommends the submission of all excised pterygia for histopathologic analysis. [43]

The examination of conjunctival SCC should determine the full extent of the lesion; rose Bengal dye is helpful for this evaluation. In addition, assess any suspicion of intraocular involvement via slit lamp examination, gonioscopy, and echography. Orbital involvement should be investigated with computed tomography (CT) scanning or magnetic resonance imaging (MRI).


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