Squamous Cell Lesions of the Conjunctiva: Evaluation of Current Grading Systems and Patho-Epidemiological Survey of Patients in Blantyre, Malawi
Kevin L Golden, Danny A Milner. Brigham and Women's Hospital, Boston, MA
Background: Conjunctival squamous cell lesions are an uncommon disease with a variable geographic incidence, being more common in countries closer to the equator. In our experience, squamous cell carcinomas of the conjunctiva are more common in Malawi. To our knowledge, no large study investigating the association of squamous cell lesions in the conjunctiva with clinical, prognostic and pathologic features in Malawian patients has been performed.
Design: We surveyed all cancers diagnosed by histology from 1997 to 2007 from the Department of Histopathology at the University of Malawi College of Medicine (Blantyre, Malawi). We selected and reviewed 160 conjunctival biopsies and applied the published grading system for pre-cancerous versus invasive cancerous epithelial lesions to further understand the patho-epidemiology of conjunctival lesions at presentation. Microscopic criteria of conjunctival lesions were evaluated in both initial biopsies and any subsequent procedures, when possible. We also analyzed the clinical outcome and subsequent follow up for all conjunctival biopsies performed in ophthalmology clinics during 2011.
Results: Squamous cell carcinoma of the conjunctiva was the second most common location for squamous cell carcinoma, after the cervix (19% vs. 44%). Application of the published grading system showed that the majority of lesions biopsied in Malawi were at the invasive stage of cancer, although pre-cancerous lesions adjacent to the site of invasion were also identified.
Conclusions: A modified clinicopathological algorithm for conjunctival squamous cell lesions in African settings is necessary due to late presentations and difficulties with adequate follow up.
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 308, Wednesday Afternoon