Global case of the month

1. What is the likely diagnosis here?

2. What are the predisposing factors?

Answers
1. Advanced ocular surface squamous cell neoplasia (OSSN)

2. Risk factors: HIV, Human papilloma virus, solar (UV) radiation and p53 genetic mutations

Discussion

OSSN tends to start at the limbus as a raised gelatinous mass or leucoplakia but presentation may be at the stage of a fungating oculo -orbital mass, as in this case. 

It may be the first evidence of HIV infection in about 50% of cases. 

There is no evidence that anti-retroviral therapy reduces the risk of OSNN so the prevalence may increase as people with HIV are living longer.

Treatment: Excision of conjunctival lesions require a 3-4mm margin. OSSN is the most common reason for orbital exenteration in Africa. 

Recurrence: 50% Recur

Spread: by local invasion