Pigmented versus nonpigmented ocular surface squamous neoplasia: A comparative study of 424 tumors

Abstract: PURPOSE: The purpose of this study was to compare the clinical features, management, and outcomes of patients with pigmented ocular surface squamous neoplasia (p-OSSN) versus nonpigmented OSSN (np-OSSN). MATERIALS AND METHODS: This was a retrospective, comparative, interventional study. RESULTS: Of 424 tumors in 414 patients, 194 were np-OSSN, and 230 were p-OSSN. The mean age at presentation of np-OSSN versus p-OSSN was 53 years (median, 55 years; range, 12–88 years) versus 50 years (50 years, 20–85 years). The statistically significant differences between np-OSSN vs p-OSSN included outdoor occupation ( n =77 (40%) vs n =120 (54%); P =0.006), limbal tumor epicenter ( n =98 (50%) vs n =153 (67%); P <0.001), diffuse tumor configuration ( n =23 (12%) vs n =6 (3%); P <0.001), and association with complexion-associated melanosis (CAM) ( n =40 (21%) vs n =187 (81%); P <0.001). The mean % of tumor pigmentation in p-OSSN was 43% (median, 35%; range, 1%–100%). The most common histopathological variant was moderate dysplasia in p-OSSN ( n = 52; 32%) and invasive squamous cell carcinoma in np-OSSN ( n = 46; 37%, P = 0.043). Over a mean follow-up period of 9 months (range, 6 months; range, 1–84 months) for np-OSSN and 7 months (median, 3 months; range, 1–51 months) for p-OSSN, the life salvage (98% vs. 99%, P = 0.536), globe salvage (90% versus 92%, P = 0.335), vision salvage (90% vs. 92%, P = 0.416), and local tumor recurrence (5% vs. 3%, P = 0.167) rates were comparable between the groups. CONCLUSION: Compared to np-OSSN, p-OSSN is commonly associated with co-existent CAM but has similar treatment outcomes.