Clinicopathological Correlation Of Clinically Suspected Ocular Surface Squamous Neoplasia: A Retrospective Cohort

Published 2026 - 44th Congress of the ESCRS

Reference: POCOR536 | Type: Free paper | DOI: 10.82333/eqcn-k816

Authors: Dr Joana da Silva Rocha* ¹ , Dr Catarina Francisco ¹ , Dr Sofia Justo ¹ , Dr Maria João Runa ¹ , Dr Renato Correia Barbosa ¹ , Dr Rui Avelino Resende ¹ , Dr Paula Tenedório ¹

¹Ophthalmology,ULS Matosinhos,Porto,Portugal

Purpose

To assess the concordance between clinical assessment and histopathological diagnosis in conjunctival and corneal lesions suspected of ocular surface squamous neoplasia (OSSN), and to identify clinical features associated with neoplastic and higher-grade disease.

Setting

Single-center retrospective study conducted at the Department of Ophthalmology, ULS Matosinhos (Porto, Portugal), including patients who underwent surgical excision of clinically suspicious ocular surface lesions between January of 2023 and February of 2026.

Methods

Medical records of patients undergoing primary excision of conjunctival or corneal lesions clinically classified as “suspicious for malignancy” or “of uncertain etiology” were reviewed. Preoperative clinical impressions were compared with histopathological findings, considered the reference standard. Associations between specific clinical features and histological diagnosis or grade (benign, CIN2, CIN3/CIS) were analyzed using Fisher’s exact test.

Results

Twenty patients were included (mean age 70.7±12.5 years; 65% male). Of the lesions clinically categorized as suspicious for malignancy (n=15), 7 were histologically confirmed as neoplastic, whereas none of the clinically doubtful lesions (n=5) showed neoplasia. Overall, neoplasia was confirmed in 35% (7/20) of cases, all corresponding to CIN, including 25% high-grade (CIN3/CIS). Pterygium was the most frequent benign diagnosis. Sentinel vessels were more frequently observed in high-grade lesions (80%) compared with lower-grade or benign lesions (33%). Papilliform morphology was more common in neoplastic lesions (42.9% vs 7.7%).

Conclusions

Clinical suspicion of OSSN resulted in histopathological confirmation in approximately one-third of cases, underscoring the diagnostic complexity of ocular surface lesions. Certain clinical features—particularly sentinel vessels and papilliform morphology—were more frequently associated with neoplastic and higher-grade disease and may assist in clinical risk stratification. Histopathological examination remains essential for definitive diagnosis.