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L. A. Alves, B. F. Fernandes, L. Fernandez, P. Zoroquiain, S. Maloney, M. N. Burnier, Jr.; Incidence of Epithelial Lesions of the Conjunctiva in a Review of 12,102 Specimens in Canada. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2990.
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Epithelial lesions are the second most common group of conjunctival specimens. Distribution is affected by geography, sunlight exposure and other factors such as HIV and HPV prevalence. It is found in all races and countries, with a higher incidence in males. Ocular surface squamous neoplasia (OSSN) is a new term that groups precancerous and malignant lesions, including conjunctival intraepithelial neoplasia (CIN) and squamous cell carcinoma (SCC). This study was done to assess the relative frequency of each epithelial lesion of the conjunctiva in Canada.
A retrospective study of 12,102 consecutive cases received during 16 years (1993-2009) at the Henry C Witelson Ocular Pathology Laboratory, Montreal, Canada was performed. Demographic data were retrieved from histopathological request forms. Specimens were categorized and analyzed by means of percentage.
Of the 12,102 specimens reviewed, 373 were conjunctival lesions (3.1%), including 96 epithelial tumors of the conjunctiva that comprised the studied sample. The average age was 59.9 + 17.6 years, and gender distribution was 66 (69%) males and 30 (31%) females. Fifteen lesions (15.4%) were classified as squamous cell papillomas (mean age, 57.3 + 16.7 years). Within the OSSN spectrum, there were 10 (10.4%) actinic keratosis (63.8 + 17.6 years), 27 (28.1%) cases of CIN with variable degrees of atypia (mild to moderate) (63.9 + 15.3 years), 15 (15.6%) carcinoma in situ (66.7 + 18.0 years), and 17 (17.0%) SCC (56.2 + 19.4 years). Two other rare cases of malignant tumors included one basal cell carcinoma andone mucoepidermoid carcinoma.
We reviewed the incidence of epithelial lesions of the conjunctiva from a single center in Canada. The distribution of our sample is similar to the one reported by the AFIP in 1994. When we compare our sample to others coming from countries with high levels of sunlight exposure, we found a lower incidence of OSSN, including SCC. Overall, the most common epithelial benign tumor in our center was squamous papilloma, which also agrees with previous literature. The incidence of SCC in our sample was lower than in countries where HPV and HIV are endemic. Our results corroborate the important role of sunlight exposure in the development of ocular surface neoplasia.
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