Spectrum of conjunctival tumours in a Spanish series: A review of 462 cases

Abstract

Introduction: To report the spectrum and frequency of conjunctiva tumours in an ocular oncology unit analysing the clinical profile of benign, precancerous and malignant conjunctival lesions. Methods: A retrospective case series of 462 consecutive patients diagnosed at the Ocular Oncology Unit of the University Hospital of Valladolid from 1992 to 2017. Results: Among 462 consecutive patients, the tumour was classified as melanocytic in 252 (54.5%) and non-melanocytic in 210 (45.5). Two hundred forty-eight males (mean age 51.63 (SD = 23.20)) and 214 females (mean age 48.27 (SD = 21.77)) were included. Mean patient age at diagnosis was 50.07 years (range = 1-92 years). The majority of tumours were benign (n = 307 (66.5%)) followed by precancerous (n = 103 (22.3%)) and finally by malignant ones (n = 52 (11.3%)). Benign lesions were predominantly found in younger individuals rather than premalignant (p < 0.05) and malignant ones (p < 0.05). Most of the melanocytic lesions were benign (88.5%), most epithelial ones were precancerous (61.4%) and most lymphoid lesions were malignant (56.3%). Tumours involving one or four quadrants of the ocular surface usually were benign, unlike tumours involving three quadrants that were malignant (16 (48.5%) p < 0.05). The majority of benign lesions were detected on females (n = 163 (53.1%)) by routine examination (n = 178 (86.4%)). However, main complaint in malignant tumours was the growth of the lesion (n = 39 (76.5%)). Conclusion: Most of the conjunctival tumours were melanocytic, mostly benign, closely followed by those of epithelial origin, with a predominance of precancerous lesions. Melanocytic, epithelial and lymphoid tumours accounted for over 90% of cases. A trend was identified with benign lesions being found in younger female patients on routine examination.

Clinical and Pathologic Presentation of Primary Ocular Surface Tumors among Zambians

“…This agrees with previous findings that melanocytic tumors of the ocular surface are rare in black populations [19]. OSSN predominantly consisted of invasive lesions, while preinvasive OSSN lesions were predominant in other studies [2, 3, 9, 11]. This finding is probably due to the clinician’s decision only to biopsy malignant looking lesions.…”

“…Histopathologic evaluation of OSTs is essential since accurate information about regional disease arrays and their distinguishing clinical features is required when de- signing programs that promote strategies for prevention and access to care, early detection, diagnosis, treatment, and palliation and for a better understanding of the natural history of a disease. In our study, epithelial nonmelanocytic lesions (predominated by OSSN) comprised the most common tumor category, similar to other studies from Africa [3,7], in contrast to studies from temperate climates where epithelial-melanocytic (mostly benign) tumors predominate [9,17,18]. This agrees with previous findings that melanocytic tumors of the ocular surface are rare in black populations [19].…”

“…However, our patients consisted mostly of young people and women, both of whom were HIV positive. This is in contrast to findings in more temperate climates where OSSN lesions are the second most common OSTs after melanocytic tumors, and it occurs predominantly occurs in elderly males with increasing incidence associated with age, sunlight exposure, and fairer skin [2,5,9].…”

“…However, the behavior, prognosis, and treatment of these lesions vary, necessitating a precise histopathologic tissue diagnosis to determine the most appropriate management [4]. Type and frequency of these tumors vary depending on the population studied [3,[5][6][7][8][9][10]. Sub-Saharan Africa has seen a rising incidence of OSTs, mostly ocular surface squamous neoplasia (OSSN) associated with the HIV pandemic [3,11,12].…”

Open book technique for conjunctival tumors: a surgical approach to the fornix

“…The anatomical location most commonly involved is the limbal bulbar conjunctiva (47%), followed by the extralimbal bulbar conjunctiva (26%) and fornix (9%) (1) . The incidence of conjunctival lesions involving the fornix ranges from 4.2% to 9% in the literature (1)(2)(3) .…”