Ocular surface squamous neoplasia: insights from 67 cases at a Quebec tertiary center

To evaluate the demographics, clinical characteristics, treatments, and outcomes of patients with ocular surface squamous neoplasia (OSSN).

A retrospective cohort study.

Patients followed for OSSN at the Centre Hospitalier de l'Université de Montréal in Quebec between 2013 and 2024.

Baseline characteristics were extracted alongside pathologic grades, treatment modalities, and recurrences.

In total, 67 eyes from 66 patients with a median age at diagnosis of 71 years (range 43-92) were identified. Of the patients, 67.2% (n = 45) were male, and 25.5% (n = 13/51) had a history of skin cancer. Lesions most frequently presented on the bulbar conjunctiva (41%, n = 57), the limbus (25.9%, n = 36), and/or the cornea (13.7%, n = 18). Lesions were papillomatous (31.6%, n = 30), gelatinous (29.5%, n = 28), and leukoplakic (23.2%, n = 22). Of the 80.6% (n = 54) of patients who underwent surgery, 36 received combination therapy with topical drops preoperatively (n = 5), postoperatively (n = 24), or both (n = 7). A total of 19.4% (13) had topical chemotherapy alone: 5-fluorouracil 1% (n = 3), and interferon α2b (n = 10). In cases in which histopathology was available (n = 52), conjunctival intraepithelial neoplasia (CIN) was seen in 87% (n = 45) (CIN1: 4% [n = 2], CIN2: 13% [n = 7], and CIN3: 69% [n = 36]) whereas 13% (n = 7) were squamous cell carcinoma. Recurrence occurred in 23.9% (n = 16). On Cox regression, recurrences were not associated with specific treatment approaches (all hazard ratio CIs crossing 1; P > 0.639) but were associated with positive margins (hazard ratio 3.892; P = 0.04).

OSSN in Quebec predominantly presents as papillomatous bulbar conjunctival lesions in the older White men. In total, 83% of biopsied lesions are of a higher grade (CIN3 and SCC), warranting efforts for earlier detection and referral.