Aggressive Conjunctival Squamous Cell Carcinoma with Treatment of 5-Fluorouracil in The

Mangusada Hospital Bali

Anak Agung Dewi Adnya Swari, Luh Putu Eka Naryati

Ophthalmology Department, Mangusada Hospital Bali

Purpose
To evaluate the efficacy of topical 5-fluorouracil (5-FU) for the treatment of conjungtival Squamous Cell
Carcinoma (SCC)
Case Illustration
A 53-year-old woman complained of a red mass from the right eye a month ago. She was a farmer. This
growth was progressively increasing and patient also complained of foreign body sensation. There was no
significant medical, surgery, personal, or family history. Her general physical and systemic examination
was within normal limits. Her visual acuity was 6/6 in both eyes; pupillary reactions, ocular movements,
color vision, intraocular pressure, and fundus examination were normal. On slit lamp examination, the red
mass of 3x4 mm was seen in the conjunctiva on the right eye. An immediate suspicion of OSSN was there

Figure 1: Conjungtival lesion

We planned a surgical exicision biopsy of the lesion and patient was fully informed of the procedure.
Lesions are excised with a 4 mm margin, dissecting down to the sclera without touching the tumor, absolute
alcohol is applied to the corneal to loosen the tissue from the cornea, and use adjuvant chemotherapy 5-
Fluorouracil. The tissue was sent to department of histopathology.
Figure 2. Section showing a tumor mass arising from the squamous epithelium cells arising from the squamous
epithelium with dysplasia and neoplastic epithelial cells infiltrating between the stroma and coarse chromatin.

A diagnosis of SCC was made in right eye. Postoperatively, the patient was put on antibiotics-corticosteroid
combination, and lubricants eye drops four times a day in right eye. This patient was followed up for 7
months, no recurrence was noted.

Figure 3. Show the eye about a 7 months, the lesion had not recurred

Discussion
SCC arising from conjungtiva is an uncommon disease world wise, the incidence of which varies
from 0.02 to 3.5 per 100.000. since the 1980s, the number of patients presenting with squamous cell
carcinoma of the conjungtiva has been increasing exponentially. This lesion has a multi factorial etiology
with interplay of several factors like exposure to ultraviolet radiation. SCC of the conjunctiva is the end-
stage of a spectrum of disease referred to as Ocular Surface Squamous Neoplasia (OSSN). OSSN
predominantly occurs in elderly woman with an average age of 56 years. This may be because jobs that
tend to expose people to sunlight over long periods of time are commonly done.
The treatment on this case for conjunctival epithelial malignancies include excision of the tumor
removal topical chemotherapy. 5-FU is currently used to inhibit the proliferation of subconjungtival
fibroblast after filtration surgery. 5-FU is a pyrimidine analogue commonly used to treat many epithelial
cancers, has been used as a primary treatment . It acts by interacting with S phase cells (those actively
synthesizing DNA). Therefore, it is suitable to treat squamous cell carcinoma because squamous tumors
are composed of rapidly proliferating abnormal epithelial cells. It has limited side effects on the normal
surface epithelium. 5-FU is an inexpensive drug, easily handled by medical personnel and its stable in
aqueous solutions for at least 3 weeks.
Conclusion
Early diagnosis and intervention can prevent major damage of SCC. Chemotherapy with 5-Fluorouracil
had some advantages and long follow up is necessary to prevent the morbidity.
Keywords
Squamous cell carcinoma, Conjungtiva, 5-Fluorouracil
References
1. Academy of Opthalmology Staff (US). 2018-2019. Opthalmic Pathology and Intraocular Tumors. Basic and
clinical science course. Section 4. San Fransisco: AAO
2. Nishtha S, Sonia H, Manpreet KG, et al. 2017. Conjungtival squamous cell carcinoma, a rare entity: case
report of 2 cases. Oncology and Cancer Case Reports. OMICS International 3:2.
3. James RW, Afshan AN, Anat g, ET AL. 2014. Management of conjungtival malignant melanoma: a review
and update. HHS Public Access. Expert Rev Opthalmol 9(3): 185-204.