Conjunctival Squamous Cell Carcinoma Research Articles

Morphological spectrum of excised conjunctival lesions in a tertiary hospital in North-Western Nigeria

Context: Conjunctiva is a transparent membrane lining the inner surface of the eyelids and the globe up to the corneoscleral limbus. It is a common site for the growth of lesions in the eye. Depending on their origin, conjunctival lesions could be non-neoplastic and neoplastic. The neoplastic lesions are either benign or malignant. These lesions can be distinguished based on the patient's history, clinical presentation and histopathological features. Aims: In this study, the pattern of excised conjunctival lesions was determined. Methods and Material: This was a 6-year (2010–2015) retrospective study of all excised conjunctival lesions diagnosed at the Pathology Laboratory of Aminu Kano Teaching Hospital. Statistical analysis used: Data were analysed with Statistical Package for Social Sciences (version 20.0; SPSS, Chicago, IL, USA). Results: A total of 198 conjunctival lesions were diagnosed during the period. The male patients were 136 (68.70%), whereas the females were 62 (31.30%) with male-to-female ratio of 2.2:1, with a mean age ± standard deviation of 37.69 ± 16.39 years. The neoplastic nature of the lesions was as follows: 54 (27.3%) were malignant, 61 (30.8%) were pre-malignant and 83 (41.9%) were benign. The most common lesions observed were conjunctival squamous cell carcinoma, dysplasia and squamous papilloma with frequencies of 50 (25.30%), 46 (23.20%) and 24 (12.10%), respectively. Conclusions: Benign lesions are the most common conjunctival lesions, whereas squamous papilloma and squamous cell carcinoma are the most common benign and malignant lesions, respectively.

Conjunctival Papillomas and Corneal Squamous Cell Carcinomas After Long-term Ciclosporin Treatment in Four Brachycephalic Dogs with Chronic Keratitis

Conjunctival Papillomas and Corneal Squamous Cell Carcinomas After Long-term Ciclosporin Treatment in Four Brachycephalic Dogs with Chronic Keratitis

Giant squamous cell carcinoma of the conjunctiva: a clinical case report

AbstractPurposeConjunctival Squamous cell carcinoma (SCC) represents a malignant disease that, if untreated, can cause irreversible loss of vision or even death. It is a rare disease, which is why the diagnostic and therapeutic approaches are not always linear. To report a case of a giant conjunctival SCC, including its diagnostic and therapeutic approach.MethodsA 82 years old man, with history of basal cell carcinoma in situ of the upper eyelid, was referred to the emergency department by a conjunctival lesion of the right eye with 3 months of evolution and rapid growth. Examination revealed a whitish, conical‐shaped temporal conjunctival lesion (16 x 18 x 6.5mm) in the right eye with no mobility relative to the scleral plane and staining with 1% toluidine blue. Orbital magnetic resonance imaging identified the temporal conjunctival lesion in the right eye, without unequivocal signs of scleral and other intraocular structures invasion.ResultsThis lesion was excised with a 4 mm margin, using 1% toluidine blue dye, through a no‐touch technique. As adjuvant therapy, we performed cryotherapy of the conjunctival margins and scleral bed, which was covered with amniotic membrane. Histological examination confirmed the presence of a well differentiated conjunctival SCC. One month after surgery, he started treatment with mitomycin‐c 0.04 mg/mL. Three months later, there were no signs of relapse.ConclusionClinical observation allows, in some cases, a high clinical suspicion. The vital staining with topical toluidine blue is an excellent aid in diagnosis, staining most lesions with high sensitivity, and in treatment, allowing to delineate surgical margins. Surgical treatment alone is associated with recurrence rates of up to about 70%, which is why adjuvant therapy, in particular cryotherapy and topical mitomycin‐c, is advocated. Although less common in the daily practice of an ophthalmologist, conjunctival SCC is potentially fatal and, therefore, deserves particular attention.

Targeted genome sequencing of negative and positive human papillomavirus induced conjunctival carcinomas

AbstractPurposeTo perform a comprehensive targeted genome sequencing of premalignant and malignant conjunctival squamous cell carcinomas in order to elucidate the genetic background of these tumours.MethodsDue to the scant knowledge of the mutational landscape in conjunctival carcinomas, we performed next‐generation sequencing of 509 genes commonly affected in human cancers. We sequenced a total of 110 tumours; 31 invasive carcinomas, 55 preinvasive and 24 coupled recurrent tumours. All cases were investigated for presence of human papillomavirus (HPV) by p16 immunohistochemistry, messenger RNA in situ hybridisation and HPV DNA PCR, and HPV positive tumours were genotyped by sequencing.Results21.4 % of the tumours were HPV positive. High‐risk HPV16 was the most commonly detected genotype (70%). There was an average of 9 mutations identified in each tumour. C to T substitutions at pyrimidine sites leading to missense mutations were the most common type of mutations. HPV negative tumours frequently harboured mutations in FGFR2, IGF1R, and EP400, whereas HPV positive tumours most frequently harboured mutations in the FOS, AKT2 and mTOR genes.ConclusionsUltraviolet radiation (UV)‐induced signature mutations were found in both HPV positive and HPV negative tumours. Different genes were affected in tumours harbouring high‐risk HPV positive tumours compared to HPV negative tumours.

AS-OCT Guided Treatment Of Diffuse Conjunctival Squamous Cell Carcinoma With Resection, Amniotic Membrane Graft And Topical Mitomycin C.

PurposeTo evaluate the efficacy of combined limited surgical resection, amniotic membrane graft and topical mitomycin C in treatment of diffuse conjunctival squamous cell carcinoma (CSCC) diagnosed and followed up by anterior segment optical coherence tomography (AS-OCT).Subjects and methodsA prospective study was performed on 24 eyes with diffuse CSCC. Fifteen eyes underwent lesion limited resection followed by postoperative topical mitomycin C 0.04% eye drop (MMC group) while nine eyes underwent complete excision and cryotherapy (no MMC group). Amniotic membrane graft was applied in all cases. The diagnosis was based on clinical and AS-OCT specific criteria of CSCC and was confirmed by histopathological results.ResultsThe study population was similar between the two groups. Mean postoperative follow-up was 27.1±4.1 months. The mean extent of the limbal involvement was 7.0±0.7 and 7.25±0.6 clock hours in MMC and no MMC groups, respectively. The mean size of conjunctival defect after tumor excision in MMC group (60.8±9.2 mm2) was significantly lower than in no MMC group (92.4±17.3 mm2). Histopathological diagnosis revealed invasive SCC in all specimens. The mean preoperative conjunctival epithelial thickness decreased significantly in both groups at 2-year follow-up. It decreased from 267±24.2 and 256±19.1 μm preoperatively to 56.7±11.6 and 60.4±9.6 μm at 2-year follow-up in MMC and no MMC groups, respectively. The mean number of MMC treatment cycles was 2.1±0.85 cycles. Recurrence was recorded in zero (0%) and 1 (11%) patients at 2-year follow-up in MMC and no MMC groups, respectively. Histopathological diagnosis revealed invasive SCC in all specimens. The mean preoperative conjunctival epithelial thickness decreased significantly in both groups at 2-year follow-up. It decreased from 267±24.2 and 256±19.1 μm preoperatively to 56.7±11.6 and 60.4±9.6 μm at 2-year follow-up in MMC and no MMC groups, respectively. The mean number of MMC treatment cycles was 2.1±0.85 cycles. Recurrence was recorded in zero (0%) and 1 (11%) patients at 2-year follow-up in MMC and no MMC groups, respectively.ConclusionThe treatment of diffuse CSCC with AS-OCT guided combined therapy includes limited surgical resection, AMG, and postoperative topical MMC, achieves a complete tumor resolution and good functional and cosmetic outcomes minimizing the burden of surgery, and improves postoperative patient comfort in our study cohort.

Conjunctival squamous cell carcinoma: prognostic factors for the recurrence and metastasis and clinicopathological characteristics at an oncological hospital in Peru

Background/aimsConjunctival squamous cell carcinoma (CSCC) is the most frequent malignant tumour of the conjunctiva, with scarce recurrence and infrequent metastasis. The purpose of this study is to describe the clinical...

Local Excision with Cryotherapy vs without Cryotherapy for Conjunctival Squamous Cell Carcinoma

Journal of the American College of Surgeons 229(4):p e159, October 2019. | DOI: 10.1016/j.jamcollsurg.2019.08.1164

ADAM3A copy number gains occur in a subset of conjunctival squamous cell carcinoma and its high grade precursors

Conjunctival squamous cell carcinoma (cSCC) and its precursors are among the most frequent ocular surface neoplasms worldwide. Copy gain of 8p11.22 and ADAM3A overexpression have been recently identified in invasive cSCC. We sought to study copy number gains using fluorescent in situ hybridization (FISH) in cSCC and the spectrum of precursor lesions. A total of 54 cases conjunctival squamous intraepithelial neoplasia (CIN), carcinoma in situ (CIS), or cSCC were studied using FISH with an ADAM3A (8p11 locus) probe and a chromosome 8 (Chr 8) centromere reference probe. Eighty one percent (44/54) of the cases presented in men and 19% (10/54) in women. The age at presentation ranged from 12 to 94 years (mean 65.5 years). Severe CIN was diagnosed in 45% (24/54) of the cases, followed by CIS in 31% (17/54), moderate CIN in 15% (8/54), invasive cSCC in 7% (4/54), and mild CIN in 2% (1/54). Nine (of 54) (17%) cases harbored ADAM3A or Chr 8 gains, with one of these cases demonstrating high level amplification. All ADAM3A alterations were restricted to high-grade lesions, including 2/17 (12%) cCIS, 1/4 (24%) cSCC, 5/24 (20%) severe CIN and 1/8 (12%) moderate CIN. Monosomy 8 was detected in 2 (4%) cases. No ADAM3A alterations were detected in non-neoplastic controls. Gains of ADAM3A/chromosome 8 occur in a subset of cSCC and its precursors. Alterations were present in high-grade lesions, sparing non-neoplastic conjunctiva and absent in tested controls. Thus, the specificity of this alteration as a biomarker for ocular SCC deserves further study.

P16 Expression Correlates with Invasive Ocular Surface Squamous Neoplasms in HIV-Infected Mozambicans

Background: p16 immunohistochemistry is widely used to diagnose human papillomavirus (HPV)-related squamous neoplasms of cervix, anogenital, head, and neck tissues. The incidence of these HPV-related squamous neoplasms is markedly increased in the HIV-infected population. Ocular surface squamous neoplasia (OSSN) is also more common in HIV-infected patients. However, the expression pattern of p16 in OSSN among HIV-infected patients is unclear. Here, we examined the expression of p16 in OSSN surgical excisions collected from a large HIV-infected cohort from ­Mozambique. Methods: OSSN surgical tissue specimens were collected from 75 Mozambican patients. Formalin-fixed, paraffin-embedded tissue blocks from these OSSNs were sectioned, stained with hematoxylin and eosin (H&E), and p16 expression by immunohistochemistry. H&E slides were reviewed to determine if OSSNs were noninvasive conjunctival intraepithelial neoplasms or invasive squamous cell carcinomas (SCC). Cases were classified as p16 positive or negative based on diffuse nuclear and cytoplasmic expression of p16 in neoplastic cells. Results: p16 positivity was found in a minority of OSSN cases (14/75). p16 positivity was significantly associated with the invasive SCC type of OSSN in HIV-infected patients (p value of 0.026). Conclusions: The majority of OSSNs in our HIV-infected cohort do not express p16. However, those cases that are p16-positive are significantly more likely to be the invasive SCC form of OSSN. We propose that p16 expression may identify more aggressive OSSNs in HIV-infected populations.

Rapidly Progressive Conjunctival Squamous Cell Carcinoma With Orbital Invasion

Rapidly Progressive Conjunctival Squamous Cell Carcinoma With Orbital Invasion

PD-L1/PD1 Expression, Composition of Tumor-Associated Immune Infiltrate, and HPV Status in Conjunctival Squamous Cell Carcinoma

PurposeConjunctival squamous cell carcinoma (SCC), a type of ocular surface neoplasia, is primarily treated by surgical resection and topical immuno- or chemotherapy. Metastatic disease may be treated with systemic chemo- or immunotherapy, albeit with variable response. The purpose of this study was to determine whether immune checkpoint blockade might be considered in the management of conjunctival SCC.MethodsIn this retrospective study, we evaluated tumor programmed death-ligand 1 (PD-L1) expression, high-risk human papillomavirus (HPV) status, and immunohistochemical expression of cluster of differentiation 3 (CD3), cluster of differentiation 8 (CD8), and programmed death 1 (PD1) in tumor-associated immune infiltrate in a series of 31 conjunctival SCCs.ResultsPD-L1 expression in ≥1% of tumor cells was noted in 14 conjunctival SCCs (47%) and was more prevalent in invasive than in situ SCC and among tumors with higher American Joint Committee on Cancer (AJCC) T category (≥T3 versus ≤T2). The density of CD3-positive T cells was higher in primary than recurrent tumors and higher in invasive than in situ tumors. Density of CD3-positive and CD8-positive T cells was higher in higher AJCC stage tumors. Density of CD8-positive T cells was higher in HPV-positive than HPV-negative tumors. PD-L1 expression correlated with a higher density of CD3-, CD8-, and PD1-positive cells in the tumor-associated immune infiltrate but not with HPV status.ConclusionsOur findings demonstrate that PD-L1 is expressed in almost half of conjunctival SCCs. The density of tumor-associated immune cells correlated with invasive SCC, stage, and HPV status in conjunctival SCC. Our findings support further studies to establish the potential application of immune checkpoint blockade in the management of conjunctival SCC.

Prognostic factors and survival for malignant conjunctival melanoma and squamous cell carcinoma over four decades.

To determine the epidemiology and survival of primary conjunctival malignant neoplasms. Retrospective analysis of primary malignant conjunctival neoplasms using Surveillance, Epidemiology, and End Results database from 1973 to 2012. Of 1661 cases, the most common neoplasms are squamous cell carcinoma (SCC) at 54.8% and melanoma at 38.8%. Mean diagnostic age for melanoma was 62.1 compared to 65.5 years for SCC (p = 0.002). 52.2% of melanoma are male versus 77.4% of SCC (p < 0.001). For SCC only age (HR: 1.09, 95% CI:1.04-1.14) is a predictor of survival. For melanoma, age (HR: 1.07, 95% CI: 1.05-1.10), male sex (HR: 2.04, 95% CI: 1.16-3.60), T4 tumors (HR: 3.38, 95% CI: 1.17-9.80) and N1 status (HR: 8.69, 95% CI: 2.75-27.42) are all survival predictors. The 5 and 10-year overall survival (OS) estimates are not significantly different between SCC and melanoma, with 70% and 50% respectively for SCC, and 71% and 50% respectively for melanoma. Median survival time is worse for blacks (52 months) compared to whites (118 months) and Asians/Native Americans/Pacific Islanders (145 months), however race was not found to be a significant prognostic factor in multivariate analysis. Five-year survival are similar between decades 1973-1982 (66.2%), 1983-1992 (69.2%), 1993-2002 (71.3%) and 2003-2012 (70.2%). Age at diagnosis is a determinant of survival for both conjunctival SCC and melanoma. Male sex, T4 and N1 staging are also important prognostic factors for melanoma. With respect to overall survival, SCC and melanoma did not differ significantly.

Pyogenic granuloma associated with conjunctival epithelial neoplasia: report of nine cases

AimsTo systematically describe the clinical and histopathological features of a case series of conjunctival carcinomatous lesions underlying as—and also masquerading—pyogenic granuloma.MethodsNine cases of conjunctival carcinomatous lesions underlying a pyogenic granuloma...

Karakteristik pasien ocular surface squamous neoplasia di Pusat Mata Nasional RS Mata Cicendo periode Januari 2012- Juni 2014

&#x0D; &#x0D; &#x0D; Background: Ocular surface squamous neoplasia (OSSN) is a broad term encompassing conjunctival intraepithelial neoplastic lesions (CIN) and invasive squamous cell carcinoma (SCC) of conjunctiva and cornea. The purpose of this study is to describe the demographic, clinical, therapy and histopathology characteristics of OSSNs patients in Cicendo Eye Center within period of January 2012 – June 2014. Methods: Patient medical records were reviewed. Fourty patients of biopsy-proven OSSN at Cicendo Eye Centre from January 2012 until June 2014 were reviewed. &#x0D; Results: Data was collected from 40 patients (41 eyes), OSSN was more frequent in men (62.5%) and had unilateral presentation (97.5%). The mean patient age was 45.9±14.7 years. The most common complaint was lump on the ocular surface (50%). The size of lesion was mostly less than 2 mm (62.5%). All of the patients were managed with surgery using wide excision and histopathology examination, of whom 46.4% cases were managed with wide excision only, 41.4% cases were managed with wide excision and application of topical mitomycin C (MMC), 12.2% cases were managed with wide excision, application of topical MMC, and cryotherapy. Histopathology examination revealed that 41.5% cases were CIN, 19.5% cases were carcinoma in situ, and 39% cases were invasive SCC. &#x0D; Conclusions: Patients with OSSN who came to Cicendo Eye Center were mostly male and had unilateral presentation. The most common clinical sign and symptom were ocular surface mass with size of the lesion less than 2 mm. Management of patient with OSSN is mostly excisional surgery only. Majority of histopathology examination showed CIN. &#x0D; &#x0D; &#x0D;

Programmed Cell Death 1 Ligand 1 and Programmed Cell Death 1 Ligand 2 Are Expressed in Conjunctival Invasive Squamous Cell Carcinoma: Therapeutic Implications

Novel cancer immunotherapies, called immune checkpoint inhibitors, have demonstrated clinical efficacy in the treatment of squamous cell carcinomas of the head and neck. Tissue expression of programmed cell death 1 ligand 1 (PD-L1) and programmed cell death 1 ligand 2 (PD-L2) has been shown to predict tumor response to these drugs. We examine the expression of prognostic immune biomarkers, PD-L1 and PD-L2, in invasive ocular surface squamous neoplasia. Retrospective case series. Eighteen cases of ocular surface or ocular adnexal invasive squamous cell carcinomas were identified in pathology case files of the Massachusetts General Hospital/Massachusetts Eye and Ear Infirmary and at the Wills Eye Hospital accessioned between January 1, 2014 and January 1, 2017. Immunohistochemical staining for PD-L1, PD-L2, CD8, and p16 was performed and graded in a standardized fashion. PD-L1 and PD-L2 were expressed on tumor cells to varying degrees, and also on some stromal cells and endothelial cells. Stromal and endothelial cell expression was also seen in control conjunctival specimens. Tumor expression of PD-L1 and PD-L2 was present on the cell membranes. All 18 (100%) of the tumors expressed PD-L1: 7 (39%) expressed a high level, 3 (17%) expressed a medium level, and 8 (44%) expressed a low level. Only 9 (50%) tumors expressed PD-L2 and it was at a low level. The expression of PD-L1 in tumor cells correlated with the presence of CD8-positive cytotoxic T lymphocytes among tumor cells (P < .01) and with the presence of CD8-positive cells in the surrounding stroma (P= .04). A subset of ocular invasive conjunctival squamous carcinomas express high levels of PD-L1 and CD8 and therefore may respond therapeutically to immune checkpoint inhibition.

Clinicopathologic presentation of malignant orbito-ocular tumors in Kano, Nigeria: A prospective multicenter study.

Background:Malignant orbito-ocular tumors are major causes of morbidity and mortality in the developing countries. Their presentation, morphologic type, and management are challenging, and earlier reports were mostly retrospective surveys. Histological analysis is essential in making correct diagnosis. Here, we determined the clinical presentations and histopathologic types of orbito-ocular tumors in some tertiary hospitals in Kano, Nigeria.Materials and Methods:This was a prospective cross-sectional multicenter clinical and pathologic study conducted between June 2012 and May 2013. A structured pro forma was used to record findings, patient's biodata, clinical presentation, type of surgical intervention, and histological diagnosis. Data were analyzed with STATA version 11.0.Results:Sixty-seven eye tumors were observed among 61 patients. There were 43 males and 18 females (male-to-female ratio = 2.4:1). Patients had a mean of 13.4 ± 18.3 with a median of 4.0 (0.5–70) years with a double peak in age distribution. The most common features were visual loss (90.2%), leukocoria (59%), proptosis (55%), and fungating mass (49.2%). The symptoms were for ≥6 months in 57.4% and unilateral in 82.1%. B-scan showed retinal masses and calcifications in 13.5% and 4.5%, respectively. Confirmation by histology was achieved in 91% with the most common tumor being retinoblastoma, conjunctival squamous cell carcinoma (SCC), and rhabdomyosarcoma with frequencies of 38 (56.6%), 11 (16.4%), and 6 (9.0%), respectively. Six patients were HIV positive and all had SCC.Conclusions:Retinoblastoma was the most common malignant orbito-ocular tumor observed in this study. Patients often present late to the hospital with visual loss.

Overexpression of cytokeratin 17 in conjunctival intraepithelial neoplasia and squamous cell carcinoma

Background Conjunctival intraepithelial neoplasia (CIN) is a preinvasive lesion of the ocular surface epithelium that can progress to squamous cell carcinoma (SCC), which has the potential to invade the nearby tissues, leading to visual loss. Unfortunately, the exact mechanisms of CIN and SCC pathogenesis, remain largely unknown. Cytokeratin 17 (CK17) functions specially among keratins as an oncoprotein which has been overexpressed in several cancers. To date, studies about the expression pattern of CK17 in CIN and SCC are limited. Aim The aims were to examine the immunohistochemical expression of CK17 in different conjunctival specimens including morphologically normal conjunctiva, pterygium, CIN, and SCC, and correlate CK17 expression with the available clinicopathological features of CIN and SCC specimens. Materials and methods The authors immunohistochemically investigated CK17 expression in 73 conjunctival specimens (40 CIN, 15 SCC, 10 pterygium, and eight morphologically normal conjunctiva). Results Overexpression of CK17 was detected in CIN and SCC specimens. On the contrary, limited basal expression of CK17 was noted in pterygium specimens and most of the morphologically normal conjunctiva. Significant higher mean of CK17 expression was found in CIN than morphologically normal conjunctiva and pterygium specimens. Moreover, the mean of CK17 expression was significantly higher in SCC specimens than CIN. Insignificant difference was detected between CK17 expression and all the clinicopathological features in CIN and SCC. Conclusion The authors can suggest that CK17 plays a role in the pathogenesis of CIN and SCC, with a possible role of CK17 in differentiation between benign and malignant conjunctival lesions.

Rapidly Progressive Conjunctival Squamous Cell Carcinoma With Orbital Invasion

A 41-year-old HIV-negative man with a history of alcoholism and tobacco use presented with a painless right lower eyelid mass for 3 months (Fig. A). On examination, the lesion appeared to originate from the conjunctiva with intact eyelid epidermis (Fig. B). There was no lymphadenopathy. Biopsy revealed moderately differentiated squamous cell carcinoma with keratin pearls (Fig. C). The patient was lost to follow-up and returned 2 months later with a rapidly enlarged lesion of the eyelid and anterior orbit (Fig. D), with radiographic evidence of orbital invasion (Fig. E). After a negative systemic work-up, the patient underwent an orbital exenteration and subsequent radiotherapy. The patient remains free of disease 8 months following surgery.Right periocular squamous cell carcinoma. A, Clinical photograph depicting right lower eyelid mass. B, Visible mass and irregularity of the palpebral and bulbar conjunctiva upon lid eversion. C, Keratin pearl noted on biopsy (H&E, 400X). D, Clinical photograph showing rapid enlargement and extension of the mass into the entire right lower eyelid and anterior orbit. E, T2-weighted coronal orbital MRI confirming invasion into the extraconal inferior orbit.

Rapidly Growing Conjunctival Squamous Cell Carcinoma Following Corneal Transplantation in a Patient with Xeroderma Pigmentosum

Rapidly Growing Conjunctival Squamous Cell Carcinoma Following Corneal Transplantation in a Patient with Xeroderma Pigmentosum

Histopathology manifestation and imaging characteristics of in vivo confocal microscopy for diagnosis of ocular surface squamous neoplasia

Objective: To study the histopathology manifestation and imaging characteristics of in vivo confocal microscopy (IVCM) for diagnosis of ocular surface squamous neoplasia (OSSN) and analyze the reliability of IVCM in differential diagnosis from OSSN cases. Methods: A prospective study. Twenty-three patients (23 eyes) with OSSN were collected from September 2015 to November 2017 in Beijing Tongren Eye center. They were underwent the examinations sequentially as follows: visual examination; slit-lamp microscope examination and ocular surface photography; color fundus image; anterior segment optical coherence tomography examination; IVCM examination and histopathology examination after surgery. With histopathology diagnosis, all subjects were divided into two groups: conjunctival intraepithelial neoplasm (CIN) and squamous cell carcinoma (SCC). Compared with histopathological findings, the IVCM results (cell morphology, cytoplasm and nucleus) of OSSN were analyzed. The difference analysis between the count data of two groups was carried out by the chi square test or Fisher's exact test. Receiver operating characteristic curve and area under the curve (AUC) were used to describe the accuracy of each parameter to differentiate SCC from OSSN. Results: There were 12 males and 11 females among the 23 patients aged (62±15) years. With the histopathological diagnosis, there were 15 cases (15 eyes) in the CIN group and 8 cases (8 eyes) in the SCC group. Eye redness, pain, foreign body sensation and tears were the symptoms of OSSN. There was no significant difference in clinical symptoms between the CIN and SCC groups. The size of tumors and the incidence of trophoblastic vessels in the SCC group were greater than those in the CIN group [8.5(6.5-15.5) mm vs. 5.8(4.0-8.5)mm, Z=4.702,P=0.029; 7/8 vs. 5/15, χ2=6.135, P=0.013). In histopathology, multilayered epithelia with cellular polymorphism, varied cytoplasm staining, and slightly thicker nuclei were observed in the CIN group. The corneal epithelial cells of SCC patients were markedly heterogeneous, and the intercellular bridge structure can be detected. Proliferative cells appeared with spindle shaped cells, nuclear mitotic figures and syncytial cells in the SCC group. The IVCM examination in the CIN group and SCC group showed that the cytoplasm was high and the ratio of nuclear plasma increased. There was no significant difference between the two groups in the size of epithelial cells, cytoplasm reflectivity, and nuclear cytoplasm ratio (P=0.053, 0.108, 0.067). The proportions of nuclear mitotic figures, spindle or chimeric cells, nests of whirlpool cells and the abnormal cells of the superficial stroma layer (8/8, 8/8, 8/8 and 8/8) in the SCC group was higher than those (2/15, 1/15, 4/15 and 0/15) in the CIN group, and the difference was statistically significant (P=0.001, 0.001, 0.003; P<0.001). Among these IVCM parameters, the abnormal cells of the superficial stroma layer had the highest diagnostic ability with the AUC value of 1.000, and the following AUC values were 0.933 for mitotic or double nuclei, 0.901 for spindle or chimeric cells, and 0.867 for the nests of whirlpool cells. Conclusions: The IVCM characteristics of OSSN are the dysplastic cells, hyper-reflective cytoplasm and increased nuclear plasma ratio in the corneal epithelium. Dysplastic cells appearing in the superficial stroma layer, nuclear mitotic figures and nests of vortex cells are the main IVCM parameters to support the malignant change of OSSN lesions. (Chin J Ophthalmol, 2018, 54: 652-660).