Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2025;15(2):5100 1 Squamous Cell Carcinoma of the Bulbar Conjunctiva: Novel Insights on Dermoscopy Sabina Vaccari1, Stephano Cedirian2,3, Giacomo Costa4, Antonio Moramarco5,6, Federico Cassini5,6, Matilde Roda5,6**, Emi Dika1** 1 Oncologic Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy 2 Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy 3 Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Italy 4 Ospedale Morgagni-Pierantoni, Forlì, Italy 5 Ophthalmology Unit, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Bologna, Italy 6 IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy **These authors co-share the last name as their contribution was the same to the article Key words: Bulbar squamous cell carcinoma, Dermoscopy, Eye surgery Citation: Vaccari S, Cedirian S, Costa G, et al. Squamous Cell Carcinoma of the Bulbar Conjunctiva: Novel Insights on Dermoscopy. Dermatol Pract Concept. 2025;15(2):5100. DOI: https://doi.org/10.5826/dpc.1502a5100 Accepted: November 23, 2024; Published: April 2025 Copyright: ©2025 Vaccari et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: S. Cedirian and S. Vaccari conceptualized and designed the study, conducted data collection and analysis, and wrote the initial draft of the manuscript. E. Dika and M. Roda contributed to data interpretation, provided critical revisions, and approved the final version of the manuscript. G. Costa, F. Cassini, M. Moramarco, E. Dika, and M. Roda assisted in study design, literature review, and editing of the manuscript. All authors read and approved the final manuscript. Corresponding Author: Stephano Cedirian, MD, Department of Medical and Surgical Sciences Alma Mater Studiorum University of Bologna, Italy. Via Massarenti, 1 - 40138 Bologna, Italy. ORCID ID: 0000-0002-9783-7864. E-mail: stephano.cedirian@studio.unibo.it Abbreviations: squamous cell carcinoma (SCC); non-cutaneous squamous cell carcinomas (ncSCC); squamous neoplasms of the ocular surface (OSSN). Image Consent Statement: I have obtained informed written consent from the patients to include these images. Introduction Ocular surface squamous neoplasia (OSSN) encompasses abnormal lesions in the squamous epithelium of the con- junctiva, cornea, and limbus, ranging from mild dysplasia to squamous cell carcinoma (SCC) [1]. Diagnosis is confirmed histopathologically [1]. The preferred treatment involves excision using the Shields’ no-touch technique with 4 mm margins, along with intraoperative cryotherapy using the double freeze-thaw method to minimize recurrence risk [1]. Case Presentation We present the case of a 70-year-old female with a rapidly growing pink-brown exophytic lesion on the perilimbal bul- bar conjunctiva of her left eye, first noticed three months 2 Research Letter | Dermatol Pract Concept. 2025;15(2):5100 Figure 1. A pink-brown exophytic growth on the perilimbal bulbar conjunctiva of the left eye of the patient. Figure 2. A white-yellowish keratin mass with pigmented spots and hairpin vessels on the lesion. The periphery shows vessels of various calibers with a centripetal pattern. prior [Fig. 1]. Videodermatoscopy revealed a white- yellowish keratin mass with pigmented spots, along with hairpin ves- sels and centripetal vessels of varying calibers at the lesion’s periphery [Fig. 2]. Suspected OSSN was excised using the no- touch technique. Histological analysis confirmed infiltrating SCC, with malignant squamous cells breaching the basement membrane and forming cord-like structures in the stroma. At the 6-month follow-up, there was no sign of recurrence, and staging exams, including a lymph node ultrasound, were negative. The incidence of non-cutaneous squamous Research Letter | Dermatol Pract Concept. 2025;15(2):5100 3 cell carcinoma (ncSCC) in the orbital region is 0.68 per 1,000,000, with conjunctival SCC accounting for 74.5% of cases [1,2]. SCC usually starts in the conjunctival epithelium and remains confined for months. Rarely, untreated or poorly excised lesions may invade deeper eye or orbital tissues [3]. Due to its slower progression, conjunctival SCC generally has better survival rates than orbital SCC [2]. Descriptions of OSSN involving dermatoscopic examination are rare in the literature [4,5]. SCC is typically described as a whitish or grayish lesion with characteristic hairpin and glomerular vessels, often showing neoangiogenesis in and around the tu- mors, which is partially consistent with our findings [4,5]. In our case, the patient’s age, rapid lesion progression, and size suggested malignancy. Dermatoscopy revealed a keratinizing tumor with a white-yellowish keratin mass and pigmented spots. The presence of hairpin vessels in a centripetal pat- tern, a previously unreported finding, further supported ma- lignancy. The presence of pigment, typically absent in SCC, added uniqueness to this case. Finally, the use of the no- touch technique in the excision is noteworthy. This method is particularly important in this anatomical region to avoid neoplastic cells seeding into a new area during the surgical procedure [1,3]. Conclusion Given the rarity of detailed dermatoscopic descriptions of OSSN in the literature, this case contributes valuable insights into the diagnostic and surgical management of such malignancies. References 1. Yeoh CHY, Lee JJR, Lim BXH, et al.The Management of Ocu- lar Surface Squamous Neoplasia (OSSN).  Int J Mol Sci. 2022; 24(1):713. DOI: 10.3390/ijms24010713. PMID: 36614155. 2. He LF, Mou P, Wei RL. Epidemiology and survival outcomes of pa- tients with orbital region non-cutaneous squamous cell carcinoma: a population-based analysis.  Front Oncol. 2023;13:1152337. DOI:10.3389/fonc.2023.1152337. PMID: 37213302. 3. Shields CL, Shields JA. Tumors of the conjunctiva and cornea. Indian J Ophthalmol. 2019;67(12):1930-1948. DOI:10.4103 /ijo.IJO_2040_19. PMID: 31755426. 4. Cinotti E, La Rocca A, Labeille B, et al. Dermoscopy for the Diagnosis of Conjunctival Lesions. Dermatol Clin. 2018;36(4): 439-449. DOI:10.1016/j.det.2018.05.01. PMID: 30201153. 5. Kozubowska K, Sławińska M, Sobjanek M. The role of dermos- copy in diagnostics of dermatological conditions of the eyelid, eyelashes, and conjunctiva - a literature review. Int J Dermatol. 2021;60(8):915-924. DOI:10.1111/ijd.15315. PMID: 33226125.