Current concepts and recent updates in the treatment of ocular surface squamous neoplasia

ABSTRACTIntroduction Ocular surface squamous neoplasia (OSSN) is a broad pathological entity that includes squamous neoplasm of conjunctival and corneal tissue. These various malignancies include conjunctival intraepithelial neoplasia (CIN), corneal epithelial dysplasia, squamous cell carcinoma (SCC), and mucoepidermoid carcinoma. OSSN diagnosis rests on exfoliative cytology, vital dyes, and imaging in the form of confocal microscopy and anterior segment optical coherence tomography. The medical management modalities are topical chemotherapy (Mitomycin C and 5 fluorouracil), immunotherapy (Interferon alpha 2b), and upcoming drugs, such as antivirals, anti-VEGF, and retinoic acid. Excision biopsy with no touch technique remains the gold standard for managing OSSN. However, surgery can lead to recurrence and unfavorable results in some cases.Areas Covered This article provides insights into the treatment aspects of OSSN with an overview of recent updates. The authors have discussed the current concept regarding the medical and surgical management of OSSN. The authors also dwell upon the recent updates along with the expert opinion.Expert Opinion- Although surgery remains the gold standard, topical drugs have revolutionized the management of OSSN. Patients should be closely followed up to look for any side effects. Cost, time duration, cosmesis, and side are the remaining major factors in deciding for medical versus surgical therapy.KEYWORDS: Ocular surface squamous neoplasiamitomycin C5-fluorouracilinterferon alpha 2bexcision biopsy Article highlights Ocular surface squamous neoplasia (OSSN) is a diverse ocular pathology that includes squamous neoplasm of conjunctival and corneal tissueThe important diagnostic modality includes exfoliative and impression cytology, vital dyes, high resolution anterior segment optical coherence tomography, and confocal microscopy.The medical management options of OSSN can be chemotherapeutic agents and immunotherapy.The gold standard for OSSN management is surgical excision biopsy by no touch technique and cryotherapy to the margins.The recent advances in OSSN management comprises human papilloma virus vaccine, light-activated belzupacap sarotalocan, verteporfin, cidofovir, bevacizumab, retinoic acid, and aloe vera.Declaration of interestsThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royaltiesReviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Additional informationFundingThis paper was not funded.