Ocular surface squamous cell neoplasia (OSSN) in HIV infection

Among the ocular surface malignancies in human immunodeficiency virus (HIV) infection, ocular surface squamous cell neoplasia (OSSN) occurs in 4–8% of patients.[1] In an Indian study, 38% of seropositivity was noted, and 26% were newly detected for HIV.[2] Peculiarities of OSSN in HIV are reduced mean age at presentation, large aggressive high-grade tumour with a higher risk of extension and increased risk of recurrence.[3] It can present either as a solitary gelatinous [Figure 1a]/nodular [Figure 1b] tumour or as a large diffuse lesion. Histopathological confirmation is indispensable for a definitive diagnosis of OSSN. Other modalities like ultrasound biomicroscopy, anterior segment-optical coherence tomography, computed tomography and magnetic resonance imaging may be needed in a tailored approach to look for the extent of tumour in adjacent structures.[4] Wide excision biopsy, following the ‘no touch’ technique and maintaining a 4 mm free margin along with cryotherapy to resected margin, is the treatment of choice. The residual surgical defect is managed by amniotic membrane transplantation. A diffuse lesion that involves >3 quadrants of the ocular surface can be managed by neoadjuvant chemotherapy with mitomycin-C, interferon-α2b or 5-flourouracil.[3,4]Figure 1: (a) Elevated gelatinous lesion at the limbus. (b) Large nodular lesion with surface leukoplakiaFinancial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.