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Invited Commentary
November 2015

Ocular Surface Squamous Neoplasia: From Blue Skies to Blue Dyes—We Still Need Our Ophthalmic Pathologists

Author Affiliations
  • 1The Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
JAMA Ophthalmol. 2015;133(11):1321-1322. doi:10.1001/jamaophthalmol.2015.3359

Without question, ocular surface squamous neoplasia (OSSN) is a solar-related condition, particularly endemic in immunosuppressed patients.1-3 This viral-related tumor of the conjunctival surface epithelium tends to occur in sun-exposed regions of the eye, most often at the nasal or temporal limbus. This tumor can have protean clinical manifestations as a gelatinous, translucent, foamy, leukoplakic, vascular, or pigmented mass.3,4 Risks for tumor growth onto the cornea, into the fornix, and rarely into the orbit, producing ultimate risk for metastatic disease, are understood. Treatment paradigms have shifted over the past 20 years from exclusive surgical removal using the “no-touch” technique with superficial corneal epitheliectomy and conjunctival cryotherapy3 to surgical or nonsurgical strategies using topical antitumor medications such as mitomycin C, 5-fluorouracil, interferon alpha-2b (also available as injection), cidofovir, photodynamic therapy, and even more curious methods, including topical aloe vera.3,5-7 The goal of therapy is complete eradication of this low-grade malignancy to prevent recurrence, orbital invasion, metastatic disease, and death.

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