Purpose: This study was conducted to show diverse clinical presentation of ocular surface squamous neoplasia with a rare presentation of caruncle squamous cell carcinoma (SCC).

Methods: All cases that had suspicious ocular lesion were included in the treatment study. A detailed history including demographic data was obtained. Clinical features regarding the type of lesion, location, and the involvement of cornea were evaluated. For all patients, excisional biopsy following “Shield’s no-touch technique” with 3 to 4 mm margins of uninvolved tissue and cryotherapy at excisional margins was done. All specimens were sent for a histopathological evaluation. Topical chemotherapy (mitomycin C, 0.02%) was used as an adjunctive therapy following surgical excision for large and diffuse ocular surface tumors. All patients were subjected to long-term regular follow-ups.

Results: Twenty-six patients (18 men and 8 women) with a mean age of 54.2 years were enrolled in this study. The results showed that the most common localization was bulbar conjunctiva (92%). Nodular lesions (46.5%) and SCC (57.5%) were the most common clinical and histopathological features, respectively. We observed one rare case of primary SCC of the left caruncle in a 68-year-old man who had an asymptomatic medial canthal mass. Recurrence was found in two patients with SCC, one of them having an orbital extension.

Conclusion: The early suspicion of ocular surface neoplasia will be accomplished with a simple excision in most cases, leading to a favorable outcome except in severe progressive cases.