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119 EW CORNEA October 2015 would want," Dr. Al-Mohtaseb said during her presentation. Risk factors for OSSN are having HIV, previous UV exposure (especial- ly in light-skinned individuals), and smoking, so these are questions to ask patients, Dr. Al-Mohtaseb said. OSSN comes in 3 forms: papilliform, gelatinous, and leukoplakic. Some- times it can be difficult to differenti- ate OSSN from pterygia or pinguecu- la, but if the lesion has a papilliform or gelatinous appearance or leuko- plakia, do a biopsy, Dr. Al-Mohtaseb said. If you're unsure about a lesion, rose bengal is helpful for differenti- ating between OSSN and pinguecula or pterygium. Flip the lids and also make sure that you're checking the lymph nodes. There is a small chance of intraocular metastasis, so always do a dilated fundus exam. With conjunctival lymphoma, it's important to ask patients if they have systemic symptoms, such as fe- ver, weight loss, or night sweats, Dr. Al-Mohtaseb said. Ask the patient if they have a history of cancer or if they have any ocular symptoms. Treatment is coordinated with an oncologist, often with external beam radiation, but some patients may require systemic chemotherapy or immunotherapy. More recently, physicians have been using subcon- junctival interferon-alpha (IFN-a), and some patients respond well to this treatment—about 80% of patients treated have no recurrence 5 years post treatment. Conjunctival melanoma With a 30% mortality rate and an ability to easily metastasize, con- junctival melanoma is one of the most feared lesions a person can have, Dr. Al-Mohtaseb said. Sixty percent of conjunctival melanomas arise from primary acquired melanosis (PAM) and 20% from nevi; 10% are de novo melano- mas. This almost exclusively occurs in whites, but do not just write if off just because the patient is not Cau- casian. Lesions can be pigmented or non-pigmented, which can delay diagnosis. For these lesions, it's important to ask patients if they have a person- al or family history of skin cancer and a history of sun exposure, smok- ing, or previous melanoma. During the exam, it is vital to evert both eyelids to look for pigmentation, Dr. Al-Mohtaseb said. Do a dilated fundus exam to look for intraocular spread and also look for lymphade- nopathy. Anterior segment OCT is much less helpful in these patients than with lymphoma; melanoma is harder to find on OCT. Avoid biop- sying these patients, but if you do, perform an excisional biopsy rather than an incisional biopsy. Local treatment for melano- ma is excision with cryotherapy or brachytherapy with mitomycin-C (MMC). Treat all pigmented lesions with excision or cryotherapy, Dr. Al-Mohtaseb said, and follow these patients closely. Any time any pig- ment shows up after you've done the excision, go back in and treat it with cryotherapy, she said. Half of all conjunctival melano- mas will recur within a patient's life- time. The melanomas that have the poorest prognosis are those that are in the caruncle, the fornix, or the eyelid margin; those where there's invasion into deeper tissues, lym- phatic invasion, or positive margin; and the 10% that arise de novo. Ocular surface squamous neoplasia "If you are going to get a malignant lesion, this would be the one you Watch for emails every Saturday, broadcasting recorded live cornea presentations from World Cornea Congress and other Cornea Society education throughout the year. All content will be archived for future reference. Learn from the experts @http://VideoEd.CorneaSociety.org Copyright ©2015 Cornea Society. All rights reserved. New for 2015! Cornea Society launches new web portal featuring free Invited Speaker and Free Paper presentations from World Cornea Congress VII VideoEd.CorneaSociety.org Watch, Learn and Share! Available on mobile devices, tablets, and desktops continued on page 121

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