Review Article

Ocular surface squamous neoplasia: Population demographics, pathogenesis and risk factors

Roland Hollhumer, Susan Williams, Pamela Michelow
African Vision and Eye Health | Vol 79, No 1 | a553 | DOI: https://doi.org/10.4102/aveh.v79i1.553 | © 2020 Roland Hollhumer, Susan Williams, Pamela Michelow | This work is licensed under CC Attribution 4.0
Submitted: 17 January 2020 | Published: 23 June 2020

About the author(s)

Roland Hollhumer, Department of Neurosciences, Division of Ophthalmology, University of the Witwatersrand, Johannesburg, South Africa; and, The Cornea Foundation, Johannesburg, South Africa
Susan Williams, Department of Neurosciences, Division of Ophthalmology, University of the Witwatersrand, Johannesburg, South Africa
Pamela Michelow, Cytology Unit, National Health Laboratory Service and Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa


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Abstract

Background: Ocular surface squamous neoplasia (OSSN) is a unifying term used to describe conjunctival intra-epithelial neoplasia, squamous cell carcinoma in situ and invasive squamous cell carcinoma.

Aim: The aim of this article was to describe the demographics, clinical features, pathogenesis and risk factors of OSSN.

Method: A literature search was conducted using the search criteria ‘ocular surface squamous neoplasia’, ‘diagnosis’, ‘epidemiology’, ‘pathogenesis’ and ‘risk factors’.

Results: Ocular surface squamous neoplasia is the most common ocular tumour, with incidence rates ranging from 0.01 to 3.4 per 100 000 persons/year. There are two main patterns  of disease presentation: older white males in temperate climates where human immunodeficiency virus (HIV) and human papilloma virus (HPV) are not associated; and a younger patient population in tropical climates where HIV and HPV are more prevalent. The pathogenesis primarily revolves around ultraviolet B exposure and HPV infection that cause genetic mutations and uncontrolled cellular proliferation, whilst HIV infection and vitamin A impair tumour surveillance mechanisms. Ocular surface squamous neoplasia is first suspected clinically before formal confirmation of the diagnosis. Morphologically, it can be divided into three groups: placoid, nodular and diffuse. Placoid lesions can further be sub-divided into gelatinous, leukoplakic and papilliform lesions. Nodular lesions have the poorest prognosis, with the highest risk of metastasis and recurrence.

Conclusion: Ocular surface squamous neoplasia is a common ocular tumour associated with ultraviolet radiation, HPV and HIV infection. The pathogenesis revolves around acquired genetic mutations, unregulated cellular proliferation and impaired tumour surveillance mechanisms.


Keywords

conjunctival neoplasm; squamous cell cancer; human immunodeficiency virus; human papillomavirus; ultraviolet radiation

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