Ocular Surface Squamous Neoplasia (OSSN)

Clinical Description

A spectrum of squamous conjunctival neoplasms that range from dysplasia to carcinoma in situ to invasive squamous cell carcinoma of the conjunctiva (SCCC). Associated with increasing age, increase UV light exposure, and immunosuppressive conditions such as

HIV/AIDS (especially in relatively young individuals), immunosuppressed organ transplant recipients. If left untreated invasive OSSN may lead to local extension that may lead to extensive ocular and periocular morbidity and may lead to death from intracranial extension and or regional metastasis.

Signs and Symptoms

• Varies with pattern of growth, size of lesions and duration.
• They include itchiness, foreign body sensation, redness, unsightly conjunctival growth or fungating tumour.
• Maybe flat or raised with increased vascularization and may appear leukoplakic and have a cauliflower appearance surface appearance

Investigations

• HIV (+/- viral load and CD4 count)
• Histology

Treatment

Medical Treatment

• Topical 5-Flourouracil 0.4% 8 hourly for a week followed by a week break; repeat for up to 3 months
• ALWAYS review weekly looking for response and complications – if complications appear STOP the medication immediately and treat as appropriate

Surgical Treatment

• Total excision of the lesion with a 2-4 mm free margin
• Extended enucleation or exenteration (total or partial) with or without lid sparing surgery in lesions invading the globe or involving the orbit.