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   Table of Contents      
LETTER TO THE EDITOR
Year : 2008  |  Volume : 56  |  Issue : 2  |  Page : 169

Pigmented squamous cell carcinoma of the limbus area: A rare case


Department of Ophthalmology, Sabzevar School of Medical Sciences, Sabzevar, Iran

Date of Web Publication16-Feb-2008

Correspondence Address:
E Shirzadeh
Department of Ophthalmology, Sabzevar School of Medical Sciences, Sabzevar
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.39136

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How to cite this article:
Shirzadeh E. Pigmented squamous cell carcinoma of the limbus area: A rare case. Indian J Ophthalmol 2008;56:169

How to cite this URL:
Shirzadeh E. Pigmented squamous cell carcinoma of the limbus area: A rare case. Indian J Ophthalmol [serial online] 2008 [cited 2019 Dec 7];56:169. Available from: http://www.ijo.in/text.asp?2008/56/2/169/39136

Dear Editor,

The incidence of squamous cell carcinoma (SCC) is 0.02 to 3.5 per 100,000. [1] Squamous cell carcinoma may rarely be pigmented and known as pigmented squamous cell carcinoma (PSCC). [2] The incidence of PSCC is very low and there are less than 30 reported cases in the literature. The majority of them have been reported to occur in skin-mucosal junctions. [1] The purpose of this presentation is to describe the clinical characteristics, treatment and histopahtologic findings of a rare variant case of conjunctiva-cornea epithelial neoplasia known as PSCC in the limbal area of the right eye of a 50-year-old Iranian man with spread onto the cornea. By history, the tumor had slowly grown during the last year. Differential diagnosis included PSCC, malignant melanoma and pigmented papilloma. On slit-lamp examination the mass size measured approximately 7 x 7 x 3 mm and it was soft, irregular and raised above the surrounding tissue. Laboratory examination included complete blood count and human immune deficiency virus (HIV) test were normal.

Treatment included complete excision and postoperative 0.02% mitomycin C, [3] four drops per day for two weeks. Microscopic view of the tumor revealed lobules of neoplastic cells with large irregular nuclei and eosinophilic cytoplasm containing much melanin pigment [Figure - 1]. Follow-up of greater than 14 months did not reveal any complications or signs of tumor recurrence.

The tumor size in our study was relatively large. Shields et al. [4] reported a similar case as ours. Therefore, these relatively large-sized tumors may be related to well differentiation of tumor. Squamous cell carcinoma occurs in sun-damaged ocular surface, usually at the limbal interpalpebral zone in elderly men as in this case. However, our patient was middle-aged. Since HIV infection increases the risk of conjunctival SCC, [5] an HIV test should be performed. Our patient was HIV-negative. Jauregui et al. [6] performed a light microscopic, histochemical and ultrastructural study on tissue obtained from a PSCC of the cornea and conjunctiva. The study revealed melanin granules, which accounted for the pigmentation of the neoplasm, present in variable numbers in neoplastic squamous cells. However, in our case, only light microscopy was performed. In conclusion, limbal area SCC may rarely be pigmented and it should be included in the differential diagnosis of pigmented tumors.


  Acknowledgment Top


The author would like to thank the Dr. Ramin Ebrahimi APCP for his help with histopathologic data.

 
  References Top

1.
Terada T, Yamagami J, Fugimoto A, Tanaka K, Sugiura M. Pigmented squamous cell carcinoma of the cheek skin probably arising from solar keratosis. Pathol Int 2003;53:468-72.  Back to cited text no. 1
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2.
Ohnishi T, Nakai K, Nagayama T, Sasaki M, Suzuki T, Watanabe S. Pigmented squamous cell carcinoma of the skin: Report of a case with epiluminescence microscopic observation. Br J Dermatol 2003;149:1292-308.  Back to cited text no. 2
    
3.
Pascuale Di MA, Espana EM, Tseng SC. A case of conjunctiva-cornea intraepithelial neoplasia successfully treated with topical mitomycin C and interferon alfa-2b in cycles. Cornea 2004;23:89-92.  Back to cited text no. 3
    
4.
Shields JA, Shields CL, Eagle RC Jr, Singh AD, Demirci H, Wolf MA. Pigmented conjunctival squamous cell carcinoma simulating a conjunctival melanoma. Am J Ophthalmol 2001;132:104-6.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.
Socioeconomic Data and Applications Centre. Hazards for Humans. Environmental Effects of Ozone Depletion, 1998. [Last accessed on 2007 Sep 12]. Available from: http://sedac.ciesin.org/ozone/docs/unep98/unep98p14.html#t2.  Back to cited text no. 5
    
6.
Jauregui HO, Klintworth GK. Pigmented squamous cell carcinoma of cornea and conjunctiva: A light microscopic, histochemical and ultrastructural study. Cancer 1976;38:778-88.  Back to cited text no. 6
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