Ocular surface squamous neoplasia in Malaysia: A 5-year review

Abstract: PURPOSE: The purpose of the study was to review the demographic profile, risk factors, clinical presentations, and treatment outcomes in patients with ocular surface squamous neoplasia (OSSN) at government cornea centers in Malaysia. MATERIALS AND METHODS: This is a retrospective cohort study of patients with proven histopathological reports of either corneal/conjunctival intraepithelial neoplasia (CIN) or squamous cell carcinoma (SCC) from January 2016 to December 2021, who were recruited. The patients’ demography, histopathology, and treatment outcomes were reviewed. RESULTS: A total of 62 eyes involving 59 patients with proven OSSN were studied. The majority of the cases were male (76.3%), with a mean age of 65.2 ± 11.81 years, and approximately 32.2% worked as farmers. Sun exposure and smoking are the predominant risk factors observed in this study. Histopathological examination revealed that 69.4% were CIN, while 30.6% were SCC. The majority of the cases were treated surgically with adjunctive cryotherapy and topical mitomycin C (MMC) postoperatively. Five cases (3 CIN, 2 SCC) recurred after surgery. Two recurrent cases were treated with topical MMC and resolved completely. Another three cases required surgical excision after chemo reduction with topical MMC. Tumor pigmentation was shown to be a significant risk factor for recurrence (odds ratio 10.7; 95% confidence interval: 1.5–75.8; P = 0.026). CONCLUSION: CIN is more common than SCC, predominantly affecting the male population in Malaysia with a background history of sun exposure and smoking. MMC is a good adjunct to surgical excision, both for primary and recurrent cases. Tumor pigmentation is a predicting factor for OSSN recurrence.