Management Of Ocular Surface Squamous Neoplasia Research Articles

Anterior High-Resolution Optical Coherence Tomography in the Diagnosis and Therapeutic Monitoring of Ocular Surface Squamous Neoplasia.

Ocular surface squamous neoplasia (OSSN) is the most common tumor of the ocular surface, ranging from mild dysplasia to invasive squamous carcinoma. Traditionally, the diagnosis of OSSN relies on histopathological confirmation followed by a full-thickness biopsy. However, in the past two decades, the therapeutic approach to OSSN has shifted from surgical intervention to topical chemotherapy regimens in clinical settings. This shift emphasizes the need for less invasive or non-invasive methods to diagnose ocular surface pathologies. Among various imaging devices, commercially available high-resolution optical coherence tomography (HR-OCT) has emerged as a powerful tool for the characterization of OSSN. HR-OCT provides an in vivo, cross-sectional view of ocular surface lesions, offering an "optical biopsy" for OSSN with high sensitivity and specificity. It provides valuable information in differentiating intraepithelial or invasive OSSN from other benign lesions. Additionally, HR-OCT can be used to monitor the response to topical chemotherapy and to detect subclinical OSSN during follow-up visits. In this article, the scanning protocol for image acquisition is presented, and image interpretation for OSSN is outlined. This standardized, practical, and reproducible approach is recommended in clinical workflows and is expected to assist clinicians in the management of OSSN.

Cytomorphological Spectrum of Ocular Surface Squamous Neoplasia in Elderly Age Group and Its Clinicopathological Correlation

ABSTRACT Background: Ocular surface squamous neoplasia (OSSN) encompasses a range of dysplastic changes from mild dysplasia to invasive carcinoma. This research aims to elucidate the cytomorphological spectrum of OSSN in the elderly age group and correlate these findings with clinical and pathological features. Methods: A retrospective analysis was conducted on elderly patients (>60 years) diagnosed with OSSN over a 5 year period. Cytological and histopathological findings were analyzed and correlated with clinical data. Results: The cytomorphological spectrum of OSSN in the elderly age group exhibited a broad range of cellular changes, from mild dysplasia to invasive squamous cell carcinoma. The predominant cytological features included increased nuclear–cytoplasmic ratio, pleomorphism, and abnormal mitotic figures. Clinically, OSSN presented most commonly as a unilateral conjunctival mass with a history of chronic irritation. Histopathologically, there was a significant correlation between the degree of dysplasia and the depth of invasion (P < 0.05). Conclusion: This research highlights the diverse cytomorphological spectrum of OSSN in the elderly age groups and emphasizes the importance of comprehensive clinicopathological correlation for accurate diagnosis and management. The predominant cytological features observed, including increased nuclear–cytoplasmic ratio, pleomorphism, and abnormal mitotic figures, reflect the underlying dysplastic alterations and provide valuable insights into the diagnosis and the classification of OSSN. Further studies are warranted to explore the potential role of impression cytology in the diagnosis and management of OSSN and to evaluate the efficacy of different treatment modalities in the elderly age group.

Ocular surface squamous neoplasia in India: a study of 438 patients.

To describe the clinical features, histopathology, treatment, and outcomes of patients with ocular surface squamous neoplasia (OSSN) presenting to a referral centre in India. Retrospective interventional study. Of 438 patients, the mean age at presentation was 49years. Human immunodeficiency virus infection was noted in 72 (16%), xeroderma pigmentosum in 22 (5%), hepatitis B virus infection in 14 (3%), and systemic cancer in 8 (2%) patients. Tumor pigmentation was noted in 243 (54%) tumors with a mean percentage of tumor pigmentation of 44% (median, 40%; range, 1 to 100%). Intraocular tumor extension was noted in 12 (3%), and orbital tumor extension in 16 (4%) eyes. Of the 381 treated lesions, excisional biopsy (n = 247; 65%) was the most common treatment modality. Of the 311 lesions with histopathology diagnosis of OSSN, invasive squamous cell carcinoma (n = 92; 30%) was the most common. Over a mean follow-up period of 11months (median, 5months; range, 1 to 108months) in 368 patients, tumor recurrence was noted in 16 (4%) eyes, globe salvage was achieved in 341 (90%) eyes, vision salvage in 338 (89%) eyes, regional lymph node metastasis occurred in 9 (2%), and metastasis-related death in 9 (2%) patients. Pigmented OSSN is common in Asian Indian population. Appropriate management of OSSN is associated with good vision, globe, and life salvage rates in India.

Observational study of ocular surface squamous neoplasia: Risk factors, diagnosis, management and outcomes at a tertiary eye hospital in South Africa

BackgroundOcular surface squamous neoplasia (OSSN) is the most common ocular surface tumour. Diagnosis and management have traditionally been by excision biopsy. Recently there has been success with the use of topical chemo or immunotherapy, which has resulted in a move from invasive diagnosis by histology to an array of non-invasive diagnostic tests.MethodsThis observational study aims to describe the characteristics of patients with OSSN at St John Eye Hospital in Johannesburg, South Africa. Non-invasive diagnostic tests (impression cytology, anterior segment-OCT, methylene blue staining) will be compared to the gold standard, histology. Treatment success, recurrence and adverse events will be documented between three treatment options that include: surgical excision, topical 5-Fluorouracil (5FU) chemotherapy, and topical 5FU with retinoic acid therapy.DiscussionThere is a trend to the use of less invasive diagnosis and management for OSSN. Minimally invasive diagnostic tests include cytology, anterior-segment OCT and methylene blue staining. The study will compare these to the gold standard histology, thereby providing evidence for their use in clinical practice. Interferon alpha 2b is commonly used as immunotherapy for OSSN. The cost of this medication is prohibitive to its adoption in a developing country. We therefore decided to use 5FU as the chemotherapeutic agent of choice in this study. The success, adverse events and recurrence rates with this agent may provide additional evidence for its use in the management of OSSN. Overall, if diagnosis and management can be implemented with good success in the outpatient environment, care can be improved for this condition in a developing country.

Role of mitomycin C in the management of ocular surface squamous neoplasia

Background: Ocular surface squamous neoplasia (OSSN) in a broader terminology recently introduced in the field of ophthalmology that includes conjunctival malignancies which ranges from mild epithelial dysplasia to invasive squamous cell carcinoma. The routinely used topical chemotherapy for OSSN is mitomycin C (MMC), 5-fluorouracil, interferon-alpha, and cidofovir, and among these, MMC is usually preferred by most of the ophthalmologists because of its cost-effectiveness and lesser side effects. Aim: The aim of study was to evaluate the role of MMC as an adjuvant therapy intraoperatively and postoperatively in the management of OSSN. Methodology: Patients in the age group of 40 years and above with a diagnosis of OSSN were included as our study subjects. The diagnosis of OSSN was made based on the clinical presentation and the cytological picture. A total of 22 patients with OSSN were taken as our study subjects. The tumor was surgically removed in toto along with 3–4 mm of uninvolved conjunctiva. Further, 0.4 mg/ml of MMC was applied over the excised site. Postoperatively, two cycles of 0.04% MMC eye drops were given for 2 weeks with a dosage of 4 times/day. It is given in two cycles, each cycle lasting for a week with an interval of 1 week in between. Results: Postoperatively, only one patient (4.5%) had recurrence which had developed after 6 months. Patients aged more than 60 years and who had the initial size of the lesion as > 8 mm were more prone to recurrence. Other postoperative complications that had occurred were one patient had allergic conjunctivitis and the other patient had punctate erosion. Conclusion: The use of MMC eye drop in the concentration of 0.04% has shown good clinical results without any serious side effects and with a very less recurrence rate during the follow-up period of 1 year when used as alternate 7-day courses.

Abstract 5155: Status and clinical relavence of G1/S cell cycle regulatory proteins in Ocular Surface Squamous Neoplasia

Abstract Purpose: Ocular Surface Squamous Neoplasia (OSSN) is a common tumour of ocular surface arising from the limbus, cornea or conjunctiva. It includes conjunctival intraepithelial neoplasia (CIN) and squamous cell carcinoma (SCC). Although confined to ocular surface, they have capability to recur (5-53%), metastasize (0-16%) and even cause death (8%).One of the most important issues still unresolved in the treatment and management of OSSN is the inability to determine factors causing disease progression. Identification of reliable biomarkers which could detect progression as well as identify high risk cases is an urgent necessity. The Cyclin D1/p16INK4a/pRb pathway plays a critical role in tumorigenesis and alterations in these proteins have been reported in various malignancies. This study was designed to explore the status of pRb, p16INK4a and cyclin D1 in various clinical stages of OSSN patients. Methods:Sixty-four histopathologically confirmed OSSN cases (44 squamous cell carcinomas and 20 conjunctival intraepithelial neoplasias) were included in this study. AJCC TNM staging was done and patients were followed up for 36 to 58 months (median 46 months). Immunohistochemical expression of total pRb (clone-13A10), phosphorylated Rb (clone-Phospho-Ser780), p16INK4a (clone-6H12), and cyclin D1 (clone-SP4) protein was evaluated. Kaplan-Meier survival and Cox regression analysis was done to assess the prognostic significance of these proteins. Results: Immunoexpression of the targeted proteins demonstrated loss /inactive form of pRb in 87% OSSN cases, p16INK4a and cyclin D1 overexpression in 28% in 63% cases respectively. From T1 to T3 AJCC category there was a progressive increase of p16INK4a (0%in T1 to 100% in T3) (P = 0.007) and cyclin D1 overexpression (25% in T1 to 88% in T4). Loss of pRb (75% in T1 to 100% in T4) (P = 0.03) was also seen. Loss of pRb expression was the earliest change which was detected in 75% cases in T1.The Kaplan Meier survival curves revealed loss of pRb (P = 0.0002, log rank analysis) as well as p16INK4a(P = 0.11, log rank analysis) and cyclin D1 over expression (P = 0.06, log rank analysis) adversely affected the disease free survival. pRb loss however emerged as the single most sensitive poor prognostic indicator in all AJCC stages of OSSN patients. Conclusion: G1/S cell cycle proteins (retinoblastoma, p16INK4aand cyclin D1) have prognostic relevance in OSSN patients. Of these pRb loss is the most useful indicator of aggressive behavior and is therefore recommended for detecting high risk OSSN patients. The dysregulation of p16INK4a, cyclin D1 and pRb proteins also plays an important role in pathogenesis of OSSN patients. Note: This abstract was not presented at the meeting. Citation Format: Sheetal Chauhan, Seema Sen, Anjana Sharma, Seema Kashyap, M. Vanathi, Neelam Pushker, Radhika Tandon. Status and clinical relavence of G1/S cell cycle regulatory proteins in Ocular Surface Squamous Neoplasia. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5155. doi:10.1158/1538-7445.AM2015-5155

Modern management of ocular surface squamous neoplasia

Ocular surface squamous neoplasia (OSSN) consists of a wide range of conjuctival and corneal lesions ranging from dysplastic lesions to invasive squamous cell carcinoma. A number of risk factors, including genetic predisposition, immunosuppression, HPV infection, ultraviolet exposure and smoking, have been associated with the appearance of OSSN. The authors discuss the recent advances in the management of OSSN, and describe surgical techniques and medical approaches to treat this disease. The authors believe that ultra-high-resolution optical coherence tomography will provide invaluable help in the diagnosis of surface lesions and their recurrences in the near future.

Mitomycin C: An effective adjuvant in the management of ocular surface squamous neoplasia

Background: Ocular surface squamous neoplasia (OSSN) forms a spectrum of dysplasia from conjunctival-corneal intraepithelial neoplasia to an invasive squamous cell carcinoma (SCC). Management of OSSN is surgical excision; however, with a high reported recurrence rates (33 to 56%). Hence, Mitomycin C, a tumor-targeted deoxyribonucleic acid (DNA) synthesis inhibitor is considered as an adjuvant following excision of primary OSSN. Aim: To report the cure and recurrence rate with excision of primary OSSN with Mitomycin C as an adjunctive ina single ocular center over 1 year period. Materials and Methods: Twelve eyes of 12 patients with histologically proven primary were included in the study between 1 st Jan 2009 and 31 st Dec. 2009. Protocol for the management comprised of surgical excision of the lesion with a 3 mm of healthy rim with cryotherapy followed by topical Mitomycin C 0.04% four times a day to all postoperative patients in 3-4 cycles of alternate on and off weekly courses. At each visit, looked for recurrence of tumor and corneal alterations like keratitis or erosions. Efficacy of Mitomycin C as an adjuvant therapy was measured in terms of clinical cure and recurrence of the tumor. Results: Average age 45.25 years with 42% below 40 years with 83% male preponderance. With a follow up period of 44.5 months, 91.7% success rate found despite late stage presentation in our study. Conclusion: Hence, we conclude that, Mitomycin C treatment following surgical excision decreases the recurrencerate of primary ocular surface neoplasia and should be considered as adjunctive therapy in primary treatment.