05/09/2024
Ocular surface squamous neoplasia (OSSN) refers to a spectrum of conditions involving neoplastic changes of the squamous epithelium of the conjunctiva and cornea. These lesions are often mistaken for a pingueculum or pterygium or noncancerous metaplasia, therefore any special features - such as feeder vessels and/or a papillomatous, gelatinous, or leukoplakic appearance - or the presence of particular risk factors - including older age, male gender, Caucasian background, heavy sun exposure, cigarette smoking, vitamin A deficiency, and exposure to petrol products - should lead to suspicion for OSSN.
ASOCT can aid with diagnosis, with OSSN demonstrating an abrupt 90-degree transition from normal to abnormal epithelium that is thickened and hyperreflective. Furthermore, ASOCT can help with monitoring for subclinical disease after the lesion has resolved clinically, in order to avoid premature termination of treatment with chemotherapy. UBM can help with determining presence or extent of deeper invasion.
Treatment options most commonly involve topical chemotherapy (IFN-α2β, 5-FU, MMC) +/- surgical excision.
Case: This patient underwent excisional biopsy using a “no-touch” technique with 4mm margins on the conjunctiva + alcohol-assisted superficial keratectomy with 2mm margins on the cornea + cryotherapy using a double freeze-thaw technique + human amniotic membrane overlay, with adjuvant topical chemotherapy using 5-FU.