Updates in Ocular Surface Tumor Diagnostics

Abstract

Purpose: To evaluate technologies and techniques available for the diagnosis of ocular surface tumors.

Methods: A review of the literature from 1947 to 2017, through the PubMed Database, was conducted in order to evaluate current diagnostic methods for ocular surface tumors.

Results: Ocular surface squamous neoplasia, conjunctival melanoma, and conjunctival lymphoma are the three most common ocular surface malignancies. Technologies available to assist with diagnosis of these conditions, in addition to full thickness biopsy, include vital dyes, aspiration and impression cytology, in vivo confocal microscopy, ultrasound biomicroscopy, genetic testing, and anterior segment optical coherence tomography.

Conclusions: Histology remains the gold standard for diagnosis for all 3 of these malignancies. However, multiple diagnostic techniques are available to assist in making preliminary and early diagnoses, in differentiating between similar-appearing lesions, and in some cases, avoiding biopsy prior to initiating treatment. As imaging and technology continue to evolve, these adjunctive techniques will likely continue to play a greater role in clinical practice.

Figure 1

An 81 year old female with OSSN of the left eye. Rose bengal highlights devitalized and metabolically deranged epithelial cells, thus highlighting her limbal tumor.

Figure 2. A 63 year old male with OSSN of the left eye

a. Slit lamp photograph of a sessile conjunctival lesion extending to the limbus. b. AS-OCT reveals an abrupt transition (arrow) between normal and thickened hyperreflective (asterisk) epithelium

Figure 3. A 56 year old male with amelanotic melanoma of the left eye

a. Slit lamp photograph of a conjunctival lesion, extending to the limbus. The mass is predominately amelanotic with the exception of small area of pigment at the limbus. b. AS-OCT showing a thin epithelium overlying a large and elevated subepithelial mass with shadowing of the underlying tissue. The OCT is consistent with the appearance of a conjunctival melanoma. c. Atypical basophilic cells with prominent nucleoli present within the substantia propria (Original magnification x40) d. Melan-A with red chromogen highlights the tumor cells within the substantia propria (Original magnification x100), consistent with conjunctival melanoma

Figure 4. A 57 year old male with conjunctival lymphoma of the left eye

a. Slit lamp photograph of the left eye showing a nasal, fleshy, salmon patch lesion. b. AS-OCT shows a dark, monomorphic, hyporeflective subepithelial lesion (arrow) with normal overlying epithelium.