Ocular surface squamous neoplasia (OSSN) encompasses a spectrum of slow-progressing lesions of the conjunctival and corneal epithelium, ranging from benign, premalignant to malignant conditions. These abnormalities include conjunctival epithelial dysplasia and carcinoma in situ, progressing to squamous cell carcinoma when there is an invasion of the underlying stroma. Although rare, OSSN is the most common non-pigmented tumor of the ocular surface. In Europe and the United States, it predominantly affects elderly men. The main risk factor is exposure to ultraviolet light. Non-modifiable risk factors include age and male gender, while modifiable risk factors include smoking, chronic trauma or inflammation, exposure to chemicals, vitamin A deficiency and local immunosuppression [1], [2], [3].

We present a case of necrotizing anterior scleritis as a masquerade syndrome for squamous cell carcinoma, which can lead to delayed diagnosis and, consequently, worsening prognosis with loss of the eye.

A 95-year-old male with a history of inflammatory pulmonary disease and prostate cancer presented to uveitis consultation with necrotizing anterior scleritis in the right eye.

The best-corrected visual acuity (BCVA) in the right eye was 20/100. Biomicroscopy (BMC) revealed scleral thinning with inflamed edges in the temporal region, with no anterior chamber (AC) inflammation or posterior segment pathology. Given the progressive scleral thinning and poor response to conventional treatment,

Most OSSN cases present as a fleshy mass or round ocular protuberance causing irritation, redness, foreign body sensation, itching, and reduced visual acuity due to astigmatism or involvement of the visual axis. Conjunctival OSSN is typically located in the bulbar region and can slowly progress toward the limbus and cornea. It is rarely observed as a bilateral or multifocal mass. Clinically, OSSN is characterized as a raised, whitish-gray lesion with irregular borders and a prominent feeder

OSSN is a significant entity due to its high potential to cause ocular and systemic morbidity. Its differential diagnosis presents a considerable challenge as it can mimic other common ophthalmic conditions, such as necrotizing anterior scleritis.

Early diagnosis is pivotal for appropriate treatment aimed at tumor eradication, prevention of recurrences, vision preservation and avoidance of medical and surgical complications. Additionally, the psychological impact of the disease and its

The authors declare that they have no competing interest.

There are more references available in the full text version of this article.

© 2025 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.