Answer to the last #DiagnosticDilemma
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The answer to the last Diagnostic Dilemma (An 89-year-old woman presented to the ophthalmology clinic with a 4-month history of redness and a sensation of a foreign body in her right eye. Slit-lamp examination revealed a red, raised lesion on the conjunctiva that extended onto the cornea with accompanying prominent blood vessels.) is A) Conjunctival squamous-cell carcinoma.

An 89-year-old woman presented to the ophthalmology clinic
with a 4-month history of redness and a sensation of a foreign body in her right eye. Examination of the fundus and evaluation of the pupillary response and intraocular pressure showed no abnormalities. Slit-lamp examination revealed a red, raised lesion on the conjunctiva that extended onto the cornea, with accompanying telangiectasia and prominent blood vessels. There was no regional lymphadenopathy.

The appearance of the lesion was suggestive of neoplasia; therefore, the patient underwent surgical resection of the lesion and reconstruction of the tissue defect with an amniotic-membrane graft. Histologic examination of the resected lesion revealed squamous-cell carcinoma in situ. The patient completed 4 weeks of adjuvant therapy with topical mitomycin C. At a follow-up visit 2 years after surgery, there was no local recurrence.

Source: NEJM
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