An update in the management of ocular surface squamous neoplasia

ABSTRACT

Introduction

Management of ocular surface squamous neoplasia (OSSN) has been a matter of debate among ocular oncologists. While surgical excision with tissue biopsy has been the gold standard, topical chemotherapy with agents such as interferon-α2b, 5-fluorouracil, and mitomycin C, as well as less invasive diagnostic modalities, are becoming increasingly popular.

Areas covered

This report provides a comprehensive review of recent data and addresses the key controversies in the management of OSSN. A MEDLINE database search was performed using the keywords ‘ocular surface squamous neoplasia,’ ‘conjunctival intraepithelial neoplasia,’ ‘conjunctival squamous cell carcinoma,’ ‘corneal intraepithelial neoplasia,’ ‘CIN,’ and ‘OSSN.’ All resulting articles published in English until December 2020 were then reviewed for pertinent references.

Expert opinion

Although tissue biopsy remains the gold standard for the diagnosis and management of OSSN, the advent of new and sophisticated imaging modalities is likely to change the approach to OSSN diagnosis for the majority of patients, while the use of topical chemotherapeutic and immunotherapeutic agents may become the mainstay of treatment.

KEYWORDS:

• Conjunctival intraepithelial neoplasia
• conjunctival squamous cell carcinoma
• high-resolution anterior segment oct
• interferon alpha 2b
• 5-fluorouracil
• mitomycin C
• plaque brachytherapy
• invasive ossn

Article highlights

• Ocular surface squamous neoplasia (OSSN) can be diagnosed clinically as a non-pigmented lesion with a gelatinous, papillary, leukoplakic, or opalescent appearance, usually originating from the limbus.

• Diagnosis of OSSN is confirmed by tissue biopsy, while non-invasive diagnostic modalities, such as high-resolution anterior segment optical coherence tomography (HR AS-OCT), can contribute to the diagnosis.

• Management of OSSN can be surgical or medical. Surgery provides immediate resolution of the disease and is the treatment of choice for invasive squamous cell carcinoma (SCC).

• Topical chemotherapeutic and immunomodulatory agents are becoming increasingly popular in the management of intraepithelial OSSN, especially for diffuse, multifocal or recurrent lesions.

• Topical agents include MMC, IFN-α2b, and 5-FU among others, with IFN-α2b being the least toxic on the ocular surface.

• Results from retrospective studies indicate that primary medical therapy may have comparable efficacy to surgical treatment in the management of non-invasive OSSN.

• A well-designed multicenter study is needed to determine the superiority of one treatment modality over the other and to assess different regimens of local therapeutic agents.

Declaration of interest

Dr. Palioura is a consultant for Alcon. Dr. Kounatidou has no financial disclosures. Both authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.