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Case Reports

Abstract

A 76-year-old woman with a history of conjunctival symblepharon and biopsy-proven mucous membrane pemphigoid (MMP) of the inferior fornix developed a new lesion of the left lower lid conjunctiva. Examination revealed localized conjunctival thickening with associated trichiasis. Biopsy confirmed squamous cell carcinoma in situ (SCCIS) of the conjunctiva. Conjunctival SCCIS encompasses a spectrum from intraepithelial neoplasia to invasive squamous cell carcinoma, and classification is based on the degree of epithelial atypia and stromal invasion. Risk factors include ultraviolet light exposure, human papillomavirus infection, chronic inflammation, and immunosuppression. In this patient, chronic cicatrizing inflammation from MMP likely contributed to carcinogenesis. Treatment options for conjunctival SCCIS include surgical excision with or without cryotherapy, topical chemotherapeutics such as mitomycin C, 5-fluorouracil, or interferon alfa-2b, and radiotherapy in selected cases. Choice of therapy should consider tumor location, extent, ocular surface health, and underlying inflammatory disease. This case highlights the importance of vigilant ocular surface surveillance in MMP patients, early biopsy of suspicious lesions, and individualized treatment planning to preserve vision while minimizing recurrence risk.