Ten-year Clinicopathological Review Of Ocular Surface Squamous Neoplasia In An Ophthalmological Center In

Mexico City

Lucero Pedro-Aguilar, M. D.

Alvarez-Melloni Diana, MDUribe-Martínez Yvette, MD

Ramirez-Miranda Arturo, MDNavas Alejandro, MD

Jimenez-Corona Aida, PhDGraue-Hernández Enrique O., MD, MSc

Financial Disclosure

•The authors have no financial in the subject matter of this poster

Background

• Ocular surface squamous neoplasia (OSSN) can present clinically in many different ways, with diagnosis of certainty resting on histopathological examination. Previous reports have associated surgical excision with high rates of recurrence1

• Reported ranges varies between 17% to 24% for dysplasia and 30% to 41% for squamous cell carcinoma2

1. Lee GA and Hirst LW. Ocular surface squamous neoplasia. Surv Ophthalmol 1995;39:429-50

2. Yousef YA and Finger PT. Squamous carcinoma and dysplasia of the conjunctiva and cornea: an analysis of 101 cases. Ophthalmology 2012;119:233-40.

Purpose

To evaluate clinical and histopathologic factors of surgically excised ocular surface squamous neoplasia associated with its recurrence

Methods

• Retrospective cases review (January 2003-October 2013)

• Confirmed histopathological diagnosis of benign, preinvasive, or invasive lesions of the conjunctiva and cornea

• Analyzed variables were tumor’s clinical appearance, size, extension, histopathological result and recurrence rate

Results

• Records of 358 patients

• 110 eyes of 108 patients (62 men, 48 women) were included

• Age 6–93 years (mean, 59.3 years± 20.7 years). Median follow-up was 20.5 months (Interquartile Range 25-75, 5 to 33)

• 49 eyes (44.5%) right eye; 57 eyes (51.8%) nasal quadrant

Results

Histopathologic classification of all lesions

Pathologic Diagnosis No eyes (%) 

Recurrence by group (%)

Benign lesions (n=40)Actinic keratosisPapillomaPseudoepitheliomatous hyperplasia 

 21 (52.5%)17 (42.5%) 2 (5%)

 0 (0%)1 (2.5%)1 (2.5%)

Total = 5%Preinvasive lesions (n=60)Mild dysplasiaModerate dysplasiaCarcinoma in situ 

 10 (16.7) 7 (11.7%)43 (71.6%)

  2 (3.3%) 1 (1.6%)14 (23.3%)Total=28.2%

Invasive lesions (n=10)Squamous cell carcinoma

 10 (100%)

 0 (0%)Total= 0%

ResultsHazards analysis of factors predictive of

carcinoma in situ recurrence

Univariate (n=43)

Multiple model (n=37)

HR (CI 95%) P value HR (CI 95%) P valueAge >=50 yearsSex (Males) Nasal locationTemporal location Corneal Extension Limbal extension Size ≥5 mm Edges with lesion CryotherapyInterferon after surgery

1.71 (0.40-7.33)1.88 (0.67-5.28)0.45 (0.15-1.30) 1.41 (0.47-4.25) 1.30 (0.44-3.87)2.72 (1.15-6.48) 1.23 (0.33-4.50) 2.49 (0.62-10.02) 1.03 (0.59-5.76)3.25 (0.73-14.60)

0.4720.230 0.1390.5300.6320.0230.7500.199 -0.123

3.23 (0.49-21.33)----3.24 (1.09-9.67) -3.45 (1.01-11.81) --

0.224----0.035 -0.048--

Conclusion

• Tumors with limbal involvement and positive margins were at high risk for recurrence

• Prospective randomized controlled surgical trials may help to provide further insight into the value of surgery in the treatment of OSSN in our population.