Management of ocular surface squamous neoplasia: Bowman Club Lecture 2021

Abstract

The gold-standard treatment for ocular surface squamous neoplasia (OSSN) has traditionally been surgical excision with wide margins and a no-touch technique. However, surgery may be associated with several unfavourable sequelae, as well as significant recurrence rates if margins are positive. In recent years, topical chemotherapy with 5-fluorouracil, interferon α−2b and mitomycin C have emerged as valuable agents capable of effectively treating OSSN with varying adverse effects. These medical treatment options usually present additional costs to the patient but can allow patients to avoid surgery with fewer long-term effects. Anterior segment high-resolution optical coherence tomography is an excellent tool for diagnosing and monitoring OSSN and can be a useful aid for both surgical and medical treatments of OSSN.

Topical pharmacotherapy for ocular surface squamous neoplasia: systematic review and meta-analysis

“…One of the main advantages of treatment with topical pharmacotherapy is that it has an effect on the entire ocular surface, including multifocal and subclinical lesions, especially in extensive disease when complete surgical excision is not possible. Topical therapeutic agents are able to penetrate into the tear drainage system and they can treat microinvasive tumors 42 , 43 .…”

Detection of Human Papillomavirus in Squamous Lesions of the Conjunctiva Using RNA and DNA In-Situ Hybridization

“…Next-generation sequencing represents another potential method by which HPV would be detected in routine clinical samples [87][88][89]. With respect to clinical advances in care, imaging, including optical coherence tomography, is increasingly being used to distinguish benign and malignant ocular surface lesions [10,[87][88][89][90].…”

“…The latter are also referred to as ocular surface squamous neoplasms (OSSNs) and include pre-invasive conjunctival intraepithelial neoplasia (CIN) and conjunctival carcinoma in situ (cCIS), in addition to invasive squamous cell carcinomas (SCC) [3][4][5][6][7][8][9]. While complete surgical excision with a no-touch technique is generally curative, when margins are positive, recurrence can occur, and medical therapies are frequently now incorporated into treatment [10]. Chronic exposure to ultraviolet radiation (UVR) is commonly implicated in both premalignant and malignant OSSNs due to deleterious effects on the DNA damage repair system, while the epitheliotropic and oncogenic human papillomavirus (HPV) is frequently detected in conjunctival papillomas [9,[11][12][13][14][15][16][17][18][19][20][21].…”

Squamous Cell Carcinoma of the Eyelid and Ocular Surface

“…Applying petroleum jelly to the lower eyelid skin is recommended to reduce skin irritation and toxicity. Additionally, it may be instructed to occlude the punctum briefly after applying the medication to minimize the risk of punctal stenosis [53].…”

“…Using topical 0.02-0.04% MMC eyedrops are very effective which show high-resolution rates ranging from 76-100% and low recurrence rates ranging from 0-20% [54][55][56][57][58]. Alvarez had recommended MMC in 4 week cycles of 0.04% four times a day for 1 week, followed by 3 weeks of no treatment, with cycles repeated until resolution [53]. Others may use MMC with shorter breaks, such as topically 4 times daily for a 1-week period followed by a 1-week hiatus to allow the ocular surface to recover, and this cycle is repeated once again.…”