Discern best surgical, medical therapy for ocular surface squamous neoplasia
Ocular surface squamous neoplasia can be treated surgically or medically. In difficult cases, combination therapy might be needed.
Reviewed by Carol L. Karp, MD
Miami-Though surgical or medical therapies are available to surgeons faced with treating ocular surface squamous neoplasia (OSSN), determining the appropriate therapy may not be so cut and dried.
Excision with cryotherapy is successful but can result in limbal stem cell deficiency when tumors are large, and lesion recurrences can occur even with negative margins.
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Chemotherapy options work well but depend heavily on patient compliance with drop instillation.
“Sometimes these cases are easy to resolve and sometimes not,” said Carol L. Karp, MD, professor of ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine. “Be ready to combine treatment options to cure the cancer.”
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Dr. Karp described a typical case of a 67-year-old woman who presented with a conjunctival and corneal lesion, which developed in the exposure zone. It had classic features that included leukoplakia, a mobile gelatinous limbal component, and an opalescent corneal lesion.
“This is a typical OSSN,” she explained, adding that OSSN is the umbrella terminology for conjunctival and corneal dysplasia up to but not including squamous cell carcinoma.
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OSSN risk factors include ultraviolet light exposure in most cases, human papilloma virus, and immune deficiency, such as HIV.
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