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Ocular surface squamous neoplasia is the umbrella term for malignancies of the conjunctiva and within the spectrum lies conjunctival intraepithelial neoplasia (CIN) – a non-invasive malignancy. CIN has been implicated with ageing, smoking and ultraviolet light exposure. The typical manifestation has been detailed as a non-pigmented conjunctival mass with feeder vessels. The main differential is melanoma (a pigmented lesion) which has a higher metastasis and mortality rate and an important differential to exclude. The authors present the case of a 56-year-old woman, with no significant past medical history, that presented with a one-month history of eye irritation. Best corrected vision was 6/9 OD and 6/6 OS and her intraocular pressure was 16mmHg. Examination revealed an elevated gelatinous brown pigmented mass with feeder vessels situated on the nasal conjunctiva of her right eye. Cytology was reported as CIN with mild dysplasia and no melanocytic cells. Medical treatment was initiated with three cycles of 0.02% mitomycin-C eye drops four times daily and each cycle lasting one week. Treatment was well tolerated and no side-effects were reported. At six months follow-up, the CIN had regressed with no recurrence. The authors commented on this alternative presentation of CIN with a pigmented lesion. Opting for medical therapy has become increasingly popular and considered superior to surgery due to avoidance of complications such as scarring. However, caution should be warranted with Mitomycin-C usage as its side-effects include limbal stem cell deficiency, photophobia and dry eye.

Conjunctival intraepithelial neoplasia in a patient presenting with pigmented conjunctival lesion.
Chaidaroon W, Dejkriengkraikul C, Isipradit S, Lertprasertsuke N.
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Annes Ahmeidat

University of Aberdeen

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