Ocular surface squamous neoplasia as the initial presenting sign of human immunodeficiency virus infection in 60 Asian Indian patients.

Abstract

To study the importance of routine human immunodeficiency virus (HIV) screening in patients with ocular surface squamous neoplasia (OSSN) and describe their clinical features and management. Retrospective study. Of 228 cases of OSSN screened for HIV by enzyme-linked immunosorbent assay, 86 (38%) patients were HIV positive. Of these 86 patients, 60 (70%) were unaware of their HIV-positive status prior to HIV screening. These 60 (26%) patients with newly detected HIV-positive status were included in this study. Ocular surface squamous neoplasia was the sole presenting feature of HIV infection in these patients. Mean age at presentation was 41years. Bilateral involvement occurred in 9 (15%) cases. The mean tumor basal diameter was 11mm. Orbital involvement was noted in 6 (9%) cases, and intraocular tumor extension occurred in 1 (1%) case. Based on American Joint Committee Classification, T2 (n=35, 51%) was most common. The primary treatment for OSSN included excision biopsy (n=52, 75%), topical chemotherapy with Mitomycin-C (n=5, 7%), extended enucleation (n=4, 6%), and orbital exenteration (n=8, 12%). Tumor recurrence occurred in 23% cases during a mean follow-up period of 9months. On histopathology, invasive squamous cell carcinoma was more common (n=38, 55%). OSSN was the presenting sign of underlying HIV infection in 26% cases, and 70% were unaware of their HIV-positive status prior to HIV screening. In this study, T2 tumor was most common, and 26% cases required extended enucleation/orbital exenteration to achieve complete tumor resection.