This case report describes the surgical excision of a squamous cell carcinoma located at the limbus of a patient's right eye, along with cryotherapy and topical Mitomycin-C to prevent recurrence. A 40-year old male presented with a reddish, irregular limbal mass in his right eye. The mass was excised locally under anesthesia along with cryotherapy. Topical Mitomycin-C drops were administered post-operatively to prevent recurrence, which was successful. Wide excision along with cryotherapy and Mitomycin-C is an effective treatment for limbal squamous cell carcinoma to cure the cancer and prevent recurrence.

1. SURGICAL EXCISION OF
LIMBAL SQUAMOUS CELL
CARCINOMA WITH
CRYOTHERAPY AND
MITOMYCIN-C
Dr. Neelam yadav
Dr.somen misra
Dr. Shubhangi Nigwekar

2. INTRODUCTION
• Squamous cell carcinomas are commonly seen in
eye at transitional zone of epithelium-the limbus
and eye lid margin1.
• Limbal lesion spreads over the ocular surface and
enters the fornices but rarely penetrates the globe.
• Cryotherapy is the application of extreme cold to
destroy abnormal or diseases tissue.
• Its goal is to decrease cell growth and
reproduction, increase cellular survival, decrease
pain and spasm, promote the constriction of blood
vessel.

3. • To prevent the high post surgical recurrence,
intraoperative 0.02% Mitomycin-C eye drops
have been used and for suspected post
operative recurrence , topical 0.02%
Mitomycin-C has been tried.
• For deep invasive carcinomas even destructive
exenteration may be needed.

4. Case Report
• A 40 year old male patient presented
with painless, progressive,reddish,thick
irregular mass in the right eye with
mild visual blurring since two months.
• Patient is HIV positive since 5year and
on zidovudine-lamivudine-nevirapine
• No history of similar complaints or
trauma in past.
• General and Systemic Examination of
patient was normal.
• Best corrected visual acuity of patient
was 6/9 in right eye and 6/6 in left eye.

5. Slit lamp examination :
• Right eye showed 4mm x
6mm,irregular,reddish,
vascularized mass at 3 o’
clock limbus which was
encroaching 4mm on the
cornea.
• Rest of the anterior and
posterior segment
examination was found to be
normal in both eyes.
• Limbal carcinoma was the
clinical diagnosis.

6. Management
• Right eye nasal limbal mass was
excised under local anesthesia.
• Deep keratectomy was performed
and a deep conjunctival excision was
done leaving a bare sclera.
• Cryotheraphy to the bulbar
conjunctiva adjacent to the incision
around the lesion and to the sclera
underlying the site excised limbal
lesion was performed to reduce the
likelihood of recurrence.
• Topical chemotherapy using
mitomycin C (0.02%) drops were
administered four times daily for 1 to
2 weeks after the corneal epithelium
had healed.

7. • Histopathology confirmed
the diagnosis of squamous
cell carcinoma and showed
stratified squamous
epithelium with disordered
proliferation of the cells
having large pleomorphic,
hyperchromatic nucleus,
prominent nucleoli irregular
membrane and scant
cytoplasm with high N:C
ratio.
• Postoperatively there was no
recurrence.

8. Discussion
• The average annual incidence of squamous cell
carcinoma of the conjunctiva across all age
groups has been estimated to be 17-20 cases
per million persons per year.
• Chronic irritation to the conjunctiva has been
considered to be a predisposing factor. It tends
to occur most frequently at transitional zones
of two kinds of epithelia, namely the limbus
and the lid margins2.

9. Discussion
• Histological picture of carcinoma in situ shows
dysplastic changes throughout the epithelium and
squamous cell carcinoma shows downward
proliferation of irregular, dysplastic squamous
epithelium with infiltration of subepithelial tissue.
• Invasive squamous cell carcinoma is
characterised by a mass composing of malignant
appearing cells invading through the basement
membrane and invade the substantia propria of
the conjunctiva or cornea.3

10. Discussion
• However post excision recurrence rate is high for which
intraoperative application of 0.02% Mitomycin-C on
bare sclera has been tried and if still recurrence is
suspected, topical 0.02% Mitomycin-C can be used as
QID for 2 weeks7.
• In our case, we performed wide total excision of the
mass with cryotherapy and post operatively topical
Mitomycin-C was used in tapering dose, which
rewarded good postoperative cosmetic result without
recurrence.

11. Discussion
• Treatment of squamous cell carcinoma ranges from
simple topical 0.02% Mitomycin C eye drops or total
surgical wide excision to exenteration based on the
size of the lesion, deeper invasion and general health
of the patient.4,5
• To prevent recurrence after excision, cryotheraphy is
a good option.

12. CONCLUSION
• Squamous cell carcinoma in patients with
concurrent AIDS are particularly likely to exhibit
rapidly progressive malignant conjunctival and
corneal neoplasm of the SSE and metastasis of
those neoplasms.
• Patients whose conjunctival and corneal SSE
tumors are excised completely by
histopathological criteria are usually cured.
• Supplementation of excision with cryotherapy
and administration of mitomycin C prevents the
likelihood of recurrence.

13. References
1.Maria et al. Squamous cell carcinoma of limbus. Indian J Ophthalmol 1965;13:68-70
2. Lee GA, Hirst LW. Ocular surface squamous neoplasia. Surv Ophthalmol 1995; 39: 429–50.
3. Waring III, GO Roth AM, Ekins MB. Clinical and pathological description of 17 cases of
corneal intraepithelial neoplasia. Am J Ophthalmol 1984; 97: 547–59.
4. Shields JA et al. Surgical management of conjunctival tumors. Arch Ophthalmol 1997; 115:
808–15.
5. J. Freedman, Rohm. Surgical management and histopathology of invasive tumours of the
cornea .British Journal of Ophthalmology 1979; 63: 632-635
6. Shields CL, Naseripour M, Shields JA. Topical mitomycin C for extensive, recurrent
conjunctival-corneal squamous cell carcinoma. Am J Ophthalmol. 2002 May;133(5):601-6.