Treatment of conjunctival squamous cell carcinoma: balancing disease eradication with minimising treatment-induced morbidity

A 41-year-old male presented with a large non-pigmented lesion on the ocular surface involving 8 clock hours of limbus, bulbar conjunctiva, and palpebral conjunctiva. Incisional biopsy confirmed poorly differentiated conjunctival squamous cell carcinoma (SCC). It was staged as a T3, N0, M0 lesion. Treatment was with surgical excision, amniotic membrane transplant, and buccal mucosa graft. Three weekly cycles of 0.04% mitomycin C were administered postoperatively. Six months following excision, although there was no evidence of residual conjunctival SCC, the patient suffered from poor vision, significant pain, and diplopia due to severe dry eye, limbal stem cell deficiency, and symblepharon.This case illustrates the difficult clinical decisions which confront the clinician when treating conjunctival SCC, particularly with balancing the need to eradicate the disease to prevent local invasion and metastatic spread on the one hand and minimising ocular morbidity on the other.