After presenting to his local ophthalmologist with a large ocular mass in his right eye that had been growing for a six-month period, a 74-year-old man with a history of ocular herpes was referred to the Ophthalmic Oncology Center at Duke Eye Center.
The patient’s diagnosis was not immediately clear, says Miguel Materin, MD, the ocular oncologist who examined the patient. The only way to determine whether the mass was malignant was to perform surgery.Because the lesion was suspicious for malignancy, Materin performed excisional biopsy combined with reconstruction with amniotic membrane transplantation. A corneal surgeon was also present during the surgery in case an unexpected corneal perforation occurred.
The surgery went smoothly with no complications, and results from ultrasound biomicroscopy showed that the lesion was on the surface rather than invading the cornea. Findings on biopsy revealed that the mass was a keloid lesion and the patient would not need further treatment.
“Keloid lesions are the consequence of previous trauma or inflammation,” Materin explains. “In this case, it was the patient’s history of ocular herpes that caused it. However, there aren’t many papers in the literature about these lesions in the eye, so we couldn’t be sure until we removed it.”
The patient continues to do well and is very pleased with his outcome, Materin says. Still, although the lesion was not cancerous, there is a chance it will relapse. Materin and a Duke corneal surgeon will continue to monitor the patient’s recovery.
The case illustrates that not every lesion that looks like cancer is necessarily cancer, Materin says. This type of benign lesion is very uncommon in the eye, but it can happen, and ophthalmologists should be aware that it is a possibility. Further, the case shows the importance of a patient’s medical history.
Most importantly though, he says, the case demonstrates the importance of teamwork among different specialists for diagnosing, treating, and following up with this type of patient. “We’re able to treat patients with these unusual conditions because we’re working together—the ophthalmic oncologist, the corneal surgeon, and the pathologist, among many others.”