“No-Touch” Technique + Partial Keratectomy For The Treatment Of Recurrent Infiltrative Conjunctival Squamous Cell Carcinoma.

To report the use of the “no-touch technique” for the treatment of recurrent infiltrative conjunctival squamous cell carcinoma

Ocular Surface Squamous Neoplasia (OSSN) is the most common non-pigmented malignant lesion in the conjunctival and corneal epithelium. It presents as a slowly progressive unilateral lesion with low malignant potential. Its etiology is not entirely clear, probably with a multifactorial origin.

A 79-year-old patient, presented with a conjunctival, vascularized and infiltrative nodular lesion in the right eye, for the las 6 months. Excision/Biopsy of the lesion was performed with safety margins of 4 mm and covered with amniotic membrane (AM). The pathological result reports well-differentiated infiltrating squamous cell carcinoma with free surgical margins. Despite adjuvant treatment with 5 cycles of 5 fluorouracil (5FU), the patient had a recurrence after 11 months, so a new resection was decided. The “No-Touch” technique with AM was performed. During the intervention, infiltration was observed in the sclera, so the surgery was completed with keratectomy of 2 mm of the limbus + superficial sclerectomy and application of cryotherapy to the conjunctival edges. Studies performed with orbital MRI rule out extension. After surgery, 4 additional cycles of 5FU, four times a day were used, 1 week “on” and 3 weeks “off” with no signs of recurrence 10 months after the intervention. Lesion recurred, so a switch to topical chemotherapy with IFNy was done, remaining stable and without signs of recurrence.

It is important to perform an excision of the OSSN following the “no touch” technique advocated by Shields in order to avoid the dispersion of tumor cells during the surgical procedure and their subsequent recurrence. Adjuvant immunotherapy has been found useful in cases of resection with positive margins or in reinterventions, thus reducing the risk of recurrence.