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Regression of Squamous Cell Carcinoma With Corneal Invasion Following Local Resection and Plaque Radiotherapy Online Only

Cameron Lee, BA1; Sara E. Lally, MD1; Carol L. Shields, MD1
[+] Author Affiliations
1Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
JAMA Ophthalmol. 2016;134(8):e161009. doi:10.1001/jamaophthalmol.2016.1009.
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This case report describes a white man in his late 70s who noticed a white mass on his right eye that grew larger over 5 months.

A white man in his late 70s noticed a white mass on his right eye that grew larger over 5 months. At presentation, his visual acuity was 20/25 OD, and an examination revealed a pink-white limbal mass temporally with dilated feeder vessels, minimal leukoplakia, and extensive corneal stromal infiltration with feathery margins (Figure, A). Ultrasound biomicroscopy demonstrated increased corneal thickness with hyperechogenicity and posterior bulging into the anterior chamber, suggesting solid tumor invasion. Based on the presumptive diagnosis of corneal-invasive squamous cell carcinoma of the conjunctiva, the management strategy included alcohol superficial keratectomy, wide surgical resection of conjunctival component using a “no touch” technique, and cryotherapy to conjunctival margins with conjunctival reconstruction.1 The corneal-infiltrative stromal component was managed with iodine 125 plaque radiotherapy directly over the affected corneal surface and adjacent sclera, designed to irradiate for a 3-mm depth.2,3 On follow-up, complete regression of both conjunctival and corneal-invasive malignancy was observed (Figure, B). Visual acuity remained 20/25 OD.

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A, Conjunctival squamous cell carcinoma with invasion into the corneal stroma, confirmed by ultrasound biomicroscopy, was managed with “no touch” surgical resection and brachytherapy. B, On follow-up, complete tumor regression was documented clinically and ultrasonographically.

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