Ocular surface squamous neoplasia: An overview

Ocular sebaceous gland carcinoma (SGC) is a relatively rare, slow growing, but most aggressive and life-threatening tumor. It accounts for around 1% of all cutaneous malignancies. In Caucasians, SGCs are rare accounting for 1-5.5% of eyelid malignancies with a high incidence rate (28-60%) reported in the Asian population. In most SGCs no obvious etiology has been identified but few cases are associated with Muir-Torre syndrome. The dysregulation of several cell signaling pathways has been reported in tumorigenesis of SGC. Recently genome sequencing of periocular SGC revealed several gene mutations like TP53 and RB1 genes. Ocular SGC is known as the ‘great masquerader’ as it mimics several benign and inflammatory conditions like chalazion and chronic blepharitis/ blepharoconjunctivitis which may be responsible for delayed diagnosis and high mortality. Clinico-pathologically ocular SGC can be broadly categorized into nodular and pagetoid subtypes. The latter is more aggressive and associated with a high rate of lymph node metastasis and recurrence hence requiring aggressive multimodal treatment. More aggressive features associated with poor prognosis include involvement of both eyelids, infiltrative growth pattern, multicentric in origin with a pattern of spread to surrounding structures like pagetoid spread, vascular, lymphatic and orbital invasion. Although wide surgical excision with tumor-free margin is the gold standard treatment for the localized nodular type of ocular SGC, but the management of advanced-stage disease, invasive or aggressive lesions and recurrence is challenging and often needs a multidisciplinary approach that can reduce the mortality rate in patients with SGC. In this review article, we report recent research in molecular pathogenesis, clinicopathological features, the importance of TNM staging, sentinel lymph node biopsy, map biopsy and immunohistochemical evaluation of tumor markers like p,Ki-67, bcl-1, and p. We also emphasized the treatment of ocular SGC, i.e. surgical excision & reconstruction, topical therapy, neoadjuvant chemotherapy, targeted therapy, and radiation therapy.

Section: Introductionmentioning

confidence: 99%

Recent updates on the management of ocular sebaceous gland carcinoma

Maurya

Gupta

Kadir³

et al. 2023

Optical biopsy – Optical coherence tomography guided excision of ocular surface squamous neoplasia

Kumar

Amar²

2023

: To report the role of optical biopsy where the preoperative spectral domain optical coherence tomography (SD OCT) features were used for surgical margin clearance in ocular surface squamous neoplasia (OSSN) excision.In this prospectiveinterventional studypatients with clinically diagnosed OSSNundergopreoperative SD OCT and mass was excised with 3mm clearance with respect to the extent on OCT. Corneal, conjunctival margins and lamellar sclera was evaluated histopathologically. Twelve eyes of 11 patients with mean age of 59.2 ± 12.2 were studied. Hyper reflective epithelium, increased thickness, abrupt transition of corneal epithelium and increase back shadow were the features of OSSN noted. The mean functional epithelial thickness and epithelial thickness were 137.5± 60.6µm and 58.5±10.8 µm respectively. The histopathology confirmed as squamous cell carcinoma (SCC) (n=4, 33.3%), carcinoma in situ (CIN) (n=8, 66.6%). In CIN 2 eyes were severe dysplasia and 6 were moderate dysplasia. Corneal clearance was noted as 100 %. Of 36 conjunctival margins, the positive margin noted in 6 eyes (50%). Nasal margin (n=3) and temporal (n=3) were the common margins. There was no difference in clearance between CIN (50%) or SCC (50%) on conjunctival side. Two eyes with recurrence required and revision excision subsequent topical chemotherapyOptical biopsy by SD OCT though is an effective method for OSSN removal. Corneal margins showed better margin clearance than conjunctival.

To study the clinical course and management of recurrent OSSN in HIV positive patient in Eastern Uttar Pradesh

Jhunjhunwala,

Bhatt

2023

We present a case of recurrent OSSN in HIV positive individual and its successful management. Patient presented to us with slow growing painless greyish mass in temporal area in interpalpebral region. He was diagnosed with HIV 2 years back and was on HAART regimen. He underwent excision for a similar looking mass in same eye 2 years back at the same time he was diagnosed with HIV. On local examination, a greyish white raised nodular gelatinous mass with feeder vessel was seen. It did not involve cornea and took up staining with rose bengal stain. complete excision biopsy using no-touch technique with a margin clearance of 4 mm followed by mitomycin-C and the remaining conjunctival defect closed with amniotic membrane graft was done. Histopathology confirmed OSSN. No recurrence was seen at 2-year follow-up.HIV shows a strong relation with OSSN and also with recurrent disease. Histopathology should always be done in interpalpebral mass excision in HIV positive patients as the recurrence rate is higher with more aggressive tumour.