Purpose. To present the clinical characteristics and difficulties in the di
agnosis of various ocular surface malignancies mimicking features of chroni
c blepharoconjunctivitis and to summarize the current therapeutic approach
and prognosis of patients. Methods. Six patients with slowly evolving signs
of persistent inflammation underwent a conjunctival biopsy after a prolong
ed course of medical treatment. The medical records of the patients were re
viewed. Results. Histopathologic examination of the biopsy specimens reveal
ed intraepithelial squamous neoplasia (one patient), invasive squamous cell
carcinoma (one patient), sebaceous carcinoma (two patients), and conjuncti
val lymphoma (two patients). Conclusion. Although uncommon, ocular surface
malignancies may involve the conjunctiva diffusely and present as chronic c
onjunctivitis. A high index of suspicion and an early histopathologic exami
nation are essen tial to not delay diagnosis.