[SavageGlow]

Source:

We present the case of a 64-year-old male patient with hypertension, dyslipidemia, type 2 diabetes mellitus, latent syphilis under surveillance, and a former smoker (96 pack years).

The patient was under periodic follow-up in oncology consultations due to a local recurrence of an SCC of the lower lip, Tumor, Node, Metastasis (TNM) staging pT2N1M0 of the American Joint Committee on Cancer (AJCC) 8th edition, in January 2021, having undergone surgery followed by adjuvant chemoradiotherapy (total radiation dose of 70 Gy in 35 fractions, five fractions per week, with concomitant cisplatin at a dose of 100 mg/m2 every three weeks on day one, 22, and 43) until May 2021.

On August 2021, the patient started to complain of eye irritation and progressive growth on the surface of the right eye (RE) (Figure 1).

He was referred to the ophthalmologic consultation, and the biomicroscopy revealed a temporal conjunctival tumor of the RE associated with chemosis and hyperemia without corneal invasion.

The histopathologic examination of the tumor biopsy showed a well-differentiated invasive SCC of the conjunctiva. The MRI of the brain and orbits described a lesion capturing contrast in the anterolateral quadrant of the RE (13 mm in greatest anteroposterior diameter and 10.6 mm in greatest transverse diameter) with poorly defined limits, appearing to extend to the upper eyelid and infiltrating the lacrimal gland.

On CT of the face and neck and whole-body positron emission tomography/CT with the glucose analog 2-[18F] fluoro-2-deoxy-d-glucose (FDG-PET/CT), there was no evidence of local or distant recurrence of the SCC of the lower lip.

The patient was referred to the ophthalmology department of a tertiary medical center and underwent a no-touch wide resection of the conjunctival lesion in February 2022. The lesion was located in the inferior temporal quadrant of the bulbar conjunctiva without the involvement of superior or inferior tarsal conjunctiva. Infiltration to the underlying scleral tissue was denoted during the procedure. Cryotherapy was applied to the wound bed and the resection bed's edges. Sponges soaked in MMC 0.02% were then applied to the wound bed and conjunctival edges for three minutes, after which a cryo-preserved human amniotic membrane was sutured, epithelial base-up, to cover the conjunctival defect. The histopathologic examination of the surgical sample confirmed a well-differentiated SCC, with invasion through the conjunctival basement membrane, TNM staging pT2cN0cM0 (AJCC 8th Edition).

At the Head and Neck Cancer multidisciplinary team meeting, a decision was made to initiate adjuvant treatment with topical chemotherapy. A 5-FU 1% topical solution was applied four times daily in the RE starting in March 2022. After completing two one-week cycles of topical treatment, the patient presented mild ocular surface toxicity with superficial punctate keratitis and two small corneal erosions, which were successfully treated with topical ofloxacin and carbomer, along with the suspension of topical 5-FU for one week. In total, three one-week cycles of topical 5-FU were completed. The decision to finish treatment with 5-FU was made upon the absence of clinical evidence of recurrence.

Ophthalmologic consultations were attended weekly during adjuvant topical chemotherapy. On subsequent ophthalmologic consultations until November 2022, there was no evidence of recurrence in the RE. The patient continues to attend regular ophthalmology and oncology appointments.

[Pyramid_Head]

Ugh, I bet that was horribly uncomfortable. I hate when I manage to get a hair in my eye.

[SavageGlow]

Originally Posted by Pyramid_Head ↗

Ugh, I bet that was horribly uncomfortable. I hate when I manage to get a hair in my eye.

I wouldn't be able to not fuck with it.

[Mr.NoCredit]

I don’t understand how a person could even live with that. I don’t mean like it’s life threatening just that once you got to the point when you can’t even close your eye lid like how do you live with that for that period of time!?! Fuck me, I could not. No way, not in a million years.

[SavageGlow]

Originally Posted by Mr.NoCredit ↗

I don’t understand how a person could even live with that. I don’t mean like it’s life threatening just that once you got to the point when you can’t even close your eye lid like how do you live with that for that period of time!?! Fuck me, I could not. No way, not in a million years.

12 years ago I woke up with Bell's Palsy so the left side of my face was completely paralyzed. I had to tape my eye closed to sleep and use drops because I couldn't blink. I think it was really bad for two years. Thankfully it's almost completely cleared up and the only remnants are that my left eyebrow doesn't raise like my right and my smile is crooked but I practice smiling still.

[Mr.NoCredit]

Originally Posted by Kimmie ↗

12 years ago I woke up with Bell's Palsy so the left side of my face was completely paralyzed. I had to tape my eye closed to sleep and use drops because I couldn't blink. I think it was really bad for two years. Thankfully it's almost completely cleared up and the only remnants are that my left eyebrow doesn't raise like my right and my smile is crooked but I practice smiling still.

Damn Kimmie! That’s crazy! Do you have any idea what brought it on? There’s nothing wrong with a crooked smile..

In return, on September 17th, 1995, I drove out to the skydiving center in Davis, California. I had already done one skydive and was in the plane for my second of the day. I jumped at around 16,000 feet, rode it in to just under 1000 feet and pulled a double malfunction. I was able to get control of my canopy but still crashed in the field. I was flown out in the “Flight for Life” helicopter and got a one month hospital stay with a broken back. I’ve never been or walked the same since. I walk but with a really heavy limp on the left side. Left leg is paralyzed from the knee down plus some other interesting ailments…

I went back after 9 months of healing, jumped for two more summers and quit when I got to 250. I crashed at jump number 195.

[SavageGlow]

Originally Posted by Mr.NoCredit ↗

Damn Kimmie! That’s crazy! Do you have any idea what brought it on? There’s nothing wrong with a crooked smile..

In return, on September 17th, 1995, I drove out to the skydiving center in Davis, California. I had already done one skydive and was in the plane for my second of the day. I jumped at around 16,000 feet, rode it in to just under 1000 feet and pulled a double malfunction. I was able to get control of my canopy but still crashed in the field. I was flown out in the “Flight for Life” helicopter and got a one month hospital stay with a broken back. I’ve never been or walked the same since. I walk but with a really heavy limp on the left side. Left leg is paralyzed from the knee down plus some other interesting ailments…

I went back after 9 months of healing, jumped for two more summers and quit when I got to 250. I crashed at jump number 195.

Holy shit! You are so lucky to be alive and you have some big balls my friend. I don't think I could do it ever again after the malfunction.

I was under a lot of stress when I was pregnant with my last kid and the trauma from the birth caused the Bell's palsy. I thought I had a stroke because everything on that side felt numb but that was just the panic because it was only my face.

[Mr.NoCredit]

Originally Posted by Kimmie ↗

Holy shit! You are so lucky to be alive and you have some big balls my friend. I don't think I could do it ever again after the malfunction.

I was under a lot of stress when I was pregnant with my last kid and the trauma from the birth caused the Bell's palsy. I thought I had a stroke because everything on that side felt numb but that was just the panic because it was only my face.

All of us who live a life get to face adversity in one way or another. That’s what living a human life is, trials, tribulations, accomplishments, achievements and so much more. I’m glad I went through mine and not yours. I can imagine what you went through and would have been scared half to death, which I’m sure you were. I’m glad your here to share. Thanks for sharing with me.

I’m grateful for every day I’m alive. I come here and see people lose their lives regularly and am all the more thankful for every waking day of mine. Even bad days are good days. If you’re alive enough to feel bad that’s still a good day. You’re alive.

[SavageGlow]

Originally Posted by Mr.NoCredit ↗

All of us who live a life get to face adversity in one way or another. That’s what living a human life is, trials, tribulations, accomplishments, achievements and so much more. I’m glad I went through mine and not yours. I can imagine what you went through and would have been scared half to death, which I’m sure you were. I’m glad your here to share. Thanks for sharing with me.

I’m grateful for every day I’m alive. I come here and see people lose their lives regularly and am all the more thankful for every waking day of mine. Even bad days are good days. If you’re alive enough to feel bad that’s still a good day. You’re alive.

I think you're very wise and I enjoy your insight.