• My Dashboard My Education Find an Ophthalmologist
  • Home
  • For Ophthalmologists
    • Meetings
      • AAO 2021
        • Meeting Information
          • Past and Future Meetings
          • Contact Information
          • Virtual Meeting Guide
          • Policies and Disclaimers
        • Program
          • Program Search
          • Program Highlights
          • Program Committees
          • CME
          • Meeting Archives
        • Expo
        • Registration
        • Hotels & Travel
          • Hotel Reservation Information
          • New Orleans
          • International Attendees
          • Hotel Meeting Space
        • Presenter Central
          • Presenter Central
          • Abstract Selection Process
          • Submission Policies
          • Subject Classification/Topics
          • Instruction Courses and Skills Transfer Labs
          • Papers and Posters
          • Videos
          • Grand Rounds Symposium
          • Program Participant and Faculty Guidelines
          • Faculty Development Program
        • Exhibitors
          • Exhibitor Central
          • Exhibitor Portal Information
          • New Exhibiting Companies
          • Exhibitor Resources
      • Mid-Year Forum
        • Registration and Travel
        • Congressional Advocacy Day
        • Advocacy Ambassador Program
        • Program
        • Schedule
        • Sponsored Attendees
        • News
      • Ophthalmology Business Summit
      • Codequest
        • Codequest Instructors
        • Claim Codequest CME or CEU Credit
      • Eyecelerator
    • Clinical Education
      • COVID-19
      • Education
        • Browse All Education
        • Courses
        • Cases
        • Learning Plans
        • Interactive
        • Focal Points
        • Wills Eye Manual
        • Disease Reviews
        • Clinical Webinars
        • Diagnose This
        • Self-Assessments
        • Educational Centers
          • Glaucoma Education Center
          • Pediatric Ophthalmology Education Center
          • Laser Surgery Education Center
          • Myopia Resources
          • Oculofacial Plastic Surgery Center
          • Redmond Ethics Center
      • Journals
      • Guidelines
        • Browse All Practice Guidelines
        • Preferred Practice Patterns
        • Clinical Statements
        • Compendium Guidelines
        • Complementary Therapy Assessments
        • Medical Information Technology
        • Ophthalmic Technology Assessments
        • Patient Safety Statements
        • Choosing Wisely
        • Low Vision
        • Eye Care for Older Adults
        • Eye Disease Statistics
        • About the Hoskins Center
      • Multimedia Library
        • Browse All Videos and Audio
        • Clinical and Surgical Videos
        • Presentations and Lectures
        • 1-Minute Videos
        • Master Class Videos
        • Basic Skills Videos
        • Interviews
        • Audio and Podcasts
        • Images
        • Submit an Image
        • Submit a Video
      • News
        • Browse All Clinical News
        • Editors' Choice
        • Headlines
        • Current Insight
      • CME Central
        • Browse All CME Activities
        • Claim CME Credit and View Transcript
        • CME Planning Resources
        • Complete Your Financial Disclosure
        • Joint Sponsorship Portal
        • LEO Continuing Education Recognition Award
        • Safe ER/LA Opioid Prescribing
        • Check Your Industry Payment Records
      • MOC
      • Resident Education
        • All Resident Education
        • OKAP and Board Exam Resources
          • OKAP Exam
          • Board Prep Resources
          • OKAP and Board Review Presentations
          • Study Flashcards
        • Resident Courses
        • Resident Videos
        • Cataract Master
        • Simulation in Resident Education
        • Pediatric Ophthalmology Education Center
        • News and Advice from YO Info
    • Membership
      • Join
      • Renew
      • Current Member
      • Volunteer
      • Physician Wellness
      • Member Directory
      • Member Obituaries
      • AAOE Membership
    • Advocacy
      • Advocacy News
      • Get Involved
        • Ways to Give
        • How to Get Involved
        • Congressional Advocacy
        • Support the Academy's Agenda
        • Research Legislation
        • Find Your Legislators
        • I Am an Advocate
        • Advocacy at Home
        • Advocate Tools
        • Best Practices for Advocating at Home
        • Social Media Toolkit
        • Letter to Editor
        • Town Hall Guide
        • Guide to Engaging With New Lawmakers
        • Resources
        • Attending a Political Fundraiser
      • OPHTHPAC
        • About Us
        • Join OPHTHPAC
        • OPHTHPAC Blog
      • Surgical Scope Fund
        • Support Surgery By Surgeons
        • Surgery By Surgeons Blog
    • Publications
      • EyeNet Magazine
        • Latest Issue
        • Archive
        • Subscribe
        • Advertise
        • Write For Us
        • Corporate Lunches
        • Contact
        • MIPS 2019
        • MIPS 2020
      • Focal Points
      • Ophthalmology
      • Ophthalmology Glaucoma
      • Ophthalmology Retina
      • YO Info
      • Scope
    • Subspecialties
      • Cataract/Anterior Segment
      • Comprehensive Ophthalmology
      • Cornea/External Disease
      • Glaucoma
      • Neuro-Ophthalmology/Orbit
      • Ocular Pathology/Oncology
      • Oculoplastics/Orbit
      • Pediatric Ophthalmology/Strabismus
      • Refractive Management/Intervention
      • Retina/Vitreous
      • Uveitis
    • IRIS Registry
      • About
      • Using the Registry
        • User Guide
        • Medicare Reporting
        • Maintenance of Certification
        • Non-EHR Reporting
      • Sign Up
        • Application Process
        • Why Participate
        • Once You've Applied: Getting Started
        • What Practices Are Saying About the Registry
      • Requirements
        • EHR Systems
        • Data & Technical Needs
      • Research
      • Registry Dashboard
      • News
    • Medicare Information
  • For Practice Management
    • Coding
      • Codequest
      • Ask the Coding Experts
      • Coding Updates and Resources
      • Coding for Injectable Drugs
      • ICD-10-CM
        • News and Advice
      • Ophthalmic Coding Specialist (OCS) Exam
    • Regulatory
      • Medicare Participation Options
      • Audits
      • Medicare Advantage Plans
        • Termination Appeal Letter
      • New Medicare Card
      • Provider Enrollment, Chain and Ownership System (PECOS)
      • HIPAA Resources
    • Practice Operations
      • Practice Management Advice
      • Lean Management
      • Cybersecurity
      • Private Equity
      • EHRs
        • Overview
        • Planning and Preparation
        • Vendor Selection
        • Implementation and Evaluation
        • Patient Portals
        • Resources
        • Ratings
    • Events
      • Annual Meeting
      • Business Summit
      • Codequest Courses
    • Leadership
      • AAOE Board of Directors
      • Leadership Program (OPAL)
    • Listservs
    • Resources
      • Practice Management Resource Library
      • Coronavirus Resources
      • Patient Education
      • Practice Forms Library
        • Practice Forms Library - Examination
        • Practice Forms Library - Financial
        • Practice Forms Library - HIPAA
        • Practice Forms Library - Human Resources
        • Practice Forms Library - Job Descriptions
        • Practice Forms Library - Patient Forms
        • Practice Forms Library - Protocols
        • Practice Forms Library - Surgery
      • Practice Analytics
        • Benchmarking Tool
        • Salary Survey
      • Consultant Directory
      • Ophthalmology Job Center
      • Practice Management for Retina
      • Reopening and Recovery
    • Get Involved
    • Medicare
      • Quality
        • Overview
        • Reporting
        • Measures
      • Promoting Interoperability
        • Overview
        • Measures
        • Attestation
        • Hardships and Exceptions
        • Audits
        • News and Advice
      • Improvement Activities
        • Overview
        • List of Improvement Activities
        • Attestation
        • Audits
      • Cost
      • Avoid a Penalty
      • Resources
        • 2019 to 2020 MIPS Changes
        • MIPS Solo and Small Practice Survival Guide
        • MIPS Glossary
        • MIPS Resources on EyeNet
        • MIPS Extreme Hardship Exceptions
        • Solo and Small-Practice Roadmap
        • MIPS Manual
        • MIPS Large Practice Roadmap
        • IRIS Registry User Guide
        • CMS Websites
        • 2020 MIPS Payments: Understanding Remittance Advice Codes
        • Final Checklist for EHR/Non-EHR 2019 MIPS Reporting
        • MIPS Tips
        • MIPS Archive
    • Membership
  • For Public & Patients
    • Eye Health A-Z
    • Symptoms
    • Glasses & Contacts
    • Tips & Prevention
    • News
    • Ask an Ophthalmologist
    • Patient Stories
    • No Cost Eye Exams
    • Español
      • A - Z de Salud Ocular
      • Síntomas
      • Anteojos y Lentes de Contacto
      • Consejos y Prevención
      • Noticias
      • Relatos de Pacientes
      • Exámenes de la vista sin costo
      • English
  • AAO 2021
    • Meeting Information
      • Past and Future Meetings
      • Contact Information
      • Virtual Meeting Help
      • Virtual Meeting Guide
      • Policies and Disclaimers
    • Program
      • Program Search
      • Program Highlights
      • Program Committees
      • CME
      • Meeting Archives
    • Expo
    • Registration
    • Hotels & Travel
      • Hotel Reservation Information
      • New Orleans
      • International Attendees
      • Hotel Meeting Space
    • Presenter Central
      • Presenter Central
      • Abstract Selection Process
      • Submission Policies
      • Subject Classification/Topics
      • Instruction Courses and Skills Transfer Labs
      • Papers and Posters
      • Videos
      • Grand Rounds Symposium
      • Program Participant and Faculty Guidelines
      • Faculty Development Program
    • Exhibitors
      • Exhibitor Central
      • Exhibitor Portal Information
      • New Exhibiting Companies
      • Exhibitor Resources
  • About
    • Who We Are
      • What We Do
      • About Ophthalmology
      • The Eye Care Team
      • Ethics and the Academy
      • History
      • Museum of Vision
      • Values
    • Governance
      • Council
      • Board of Trustees
      • Committees
      • Academy Past Presidents
      • Secretariats
      • Elections
      • Academy Blog
      • Academy Staff Leadership
    • Leadership Development
    • Awards
      • Laureate Recognition Award
      • Outstanding Advocate Award
      • Outstanding Humanitarian Service Award
      • International Blindness Prevention Award
      • Distinguished Service Award
      • Guests of Honor
      • Secretariat Award
      • Straatsma Award
      • Achievement Award Program
      • Artemis Award
      • EnergEYES Award
      • International Education Award
      • International Scholar Award
      • Commitment to Advocacy Award
      • Visionary Society Award
    • Financial Relationships
    • Policy Statements
    • Related Organizations
      • Subspecialty/Specialized Interest Society Directory
      • State Society Directory
      • Subspecialty/Specialized Interest Society Meetings
      • State Society Meetings
      • Resources for Societies
    • Year in Review
      • 2019 Year in Review
  • Foundation
    • About
      • Funding Allocations and Sources
      • 2019-2020 Annual Report
      • Annual Report Archives
      • News From the Chair
      • Foundation Staff
    • Our Impact
      • Partners for Sight
      • Donor Spotlights
      • Global Ophthalmic Community
      • Sponsorships
      • Patients and the Public
    • Giving Options
      • Our Supporters
      • Estate and Planned Giving
      • Ophthalmic Business Council
    • Orbital Gala
      • Why Attend
      • Photo Recap
      • Corporate Support Opportunities
      • Tribute Gifts
      • Silent Auction
      • Corporate Sponsors
    • Donate
    • Museum of the Eye Campaign
      • Museum Supporters
  • Museum of the Eye
    • Visit
    • Events
    • Explore
      • Research and Resources
      • Collection Search
      • Previous Exhibits
      • Oral Histories
      • Biographies
    • Volunteer
    • Mailing List
    • Donate
    • About the Museum
      • Museum Blog
  • Young Ophthalmologists
    • YO Info
    • Learn to Bill
    • Engage with the Academy
  • Senior Ophthalmologists
    • Scope
    • Practice Transitions
  • International Ophthalmologists
    • Global Programs and Resources for National Societies
    • Awards
    • Global Outreach
  • Residents
  • Medical Students
×
Log In Create an Account
  • For Ophthalmologists
  • For Practice Management
  • For Public & Patients
  • About
  • Foundation
  • Museum of the Eye
  • COVID-19
  • Journals
  • Education
    • Education
    • Courses
    • Cases
    • Learning Plans
    • Interactive
    • Focal Points
    • Wills Eye Manual
    • Disease Reviews
    • Clinical Webinars
    • Diagnose This
    • Self-Assessments
    • Education Centers
      • Glaucoma Education Center
      • Pediatric Ophthalmology Education Center
      • Laser Surgery Education Center
      • Oculofacial Plastic Surgery Center
      • Redmond Ethics Center
      • Myopia Resources
  • Guidelines
    • Practice Guidelines
    • Preferred Practice Patterns
    • Clinical Statements
    • Ophthalmic Technology Assessments
    • Patient Safety Statements
    • Complementary Therapy Assessments
    • Compendium Guidelines
    • Medical Information Technology
    • Low Vision
    • Choosing Wisely
    • Eye Care for Older Adults
    • Eye Disease Statistics
    • About the Hoskins Center
    • Artificial Intelligence
    • Premium IOLs
  • Multimedia
    • Multimedia Library
    • Video
      • 1-Minute Videos
      • Presentations and Lectures
      • Master Class Videos
      • Basic Skills Videos
      • Clinical and Surgical Videos
      • Interviews
      • Resident Lectures
      • Submit a Video
    • Audio and Podcasts
    • Images
      • Submit an Image
  • News
    • Clinical News
    • Editors' Choice
    • Headlines
    • Current Insight
  • CME
    • CME Central
    • Claim CME Credit and View Transcript
    • CME Planning Resources
    • Complete Your Financial Disclosure
    • Joint Sponsorship Portal
    • LEO Continuing Education Recognition Award
    • Safe ER/LA Opioid Prescribing
    • Check Your Industry Payment Records
  • MOC
  • Residents
    • Resident Education
    • OKAP and Board Exam Resources
      • OKAP Exam
      • Board Prep Resources
      • OKAP and Board Review Presentations
      • Study Flashcards
    • Resident Courses
    • Resident Videos
    • Cataract Master
    • Simulation in Resident Education
    • Diversity and Inclusion Education
    • Pediatric Ophthalmology Education Center
    • News and Advice from YO Info
    • Clinical Education /
    • Book Excerpts /
    • Basic and Clinical Science Course - Excerpt
  • 2020–2021 BCSC Basic and Clinical Science Course™

    Go to Academy Store Learn more and Purchase.

    4 Ophthalmic Pathology and Intraocular Tumors

    Part I: Ophthalmic Pathology

    Chapter 5: Conjunctiva

    Neoplasia

    Conjunctival specimens, particularly those involving potential malignancies, require special submission procedures along with excellent communication between the clinician and the pathologist to optimize prognosis and treatment. Techniques such as immunohistochemistry (IHC), flow cytometry, and in situ hybridization, as well as molecular studies, may be required for an accurate diagnosis and prognostication or for determining whether targeted therapy may be appropriate for the patient. See also Chapter 3.

    Squamous Epithelial Lesions

    Squamous papilloma

    The most common ocular surface neoplasms are those of the squamous family. Of these, the most common benign variant is squamous papilloma. Clinically, squamous papilloma may be divided into pedunculated and sessile subtypes.

    Pedunculated papilloma is an exophytic, pink-red, strawberry-like frond frequently localized to the caruncle (Fig 5-15A), plica semilunaris, or forniceal conjunctiva. It occurs most commonly in children and young adults, with multiple lesions sometimes present in affected patients. Pedunculated papilloma is associated with human papillomavirus (HPV) infection, subtypes 6 and 11. Histologic examination of a pedunculated papilloma demonstrates fingerlike projections of hyperplastic squamous epithelium with a central fibrovascular core (Fig 5-15B). Goblet cells may be present as in normal conjunctival epithelium. When overlying tear film disruption results in exposure, the number of goblet cells may become reduced and the surface keratinized. Neutrophils may be seen within the epithelium, and a chronic inflammatory infiltrate is frequently present in the stroma. Pedunculated papillomas typically exhibit benign behavior and rarely undergo malignant transformation.

    A sessile papilloma generally arises on the bulbar conjunctiva, especially at the limbus, and occurs more commonly in adults. This type of papilloma is also associated with HPV infection, subtypes 16 and 18—the same subtypes associated with squamous malignancies. Clinical features worrisome for malignant transformation include leukoplakia (ie, white patches indicative of keratinization), inflammation, atypical vascularity, and corneal involvement. Histologically, a sessile papilloma exhibits a broad base and lacks the prominent fingerlike projections seen in a pedunculated papilloma. The epithelium is hyperplastic with intervening fibrovascular cores but is otherwise normal. The presence of nuclear hyperchromatism and pleomorphism, altered maturation (dysplasia), dyskeratosis, and frequent mitotic figures suggests a diagnosis of ocular surface squamous neoplasia.

    Figure 5-15 Squamous papilloma. A, Clinical photograph shows squamous papilloma located at the caruncle (arrows).B, The epithelium is hyperplastic with fingerlike projections surrounding fibrovascular cores.

    (Part A courtesy of George J. Harocopos, MD.)

    Ocular surface squamous neoplasia

    Ocular surface squamous neoplasia (OSSN) comprises a wide spectrum of dysplastic changes of the ocular surface epithelium, including conjunctival and corneal intraepithelial neoplasia (CIN), squamous cell carcinoma in situ, and squamous cell carcinoma (SCC), which, by definition, invades through the epithelial basement membrane (Fig 5-16).

    The prevalence of OSSN is increased in equatorial regions of the world. Ultraviolet (UV) light exposure is a known risk factor for the condition, especially in individuals with light skin pigmentation. Some reports have shown mutations in tumor suppressor genes such as p53 secondary to UV light exposure. A hereditary impairment of DNA repair (as in xeroderma pigmentosum) also increases the risk of OSSN. In addition, OSSN occurs more frequently in patients who are immunosuppressed, such as those with HIV infection/AIDS, and in those with ocular surface HPV infection (subtypes 16 and 18). OSSN is commonly the first presenting sign of HIV/AIDS in regions where HIV infection is endemic. HIV-associated OSSN may demonstrate rapid growth and aggressive behavior, and HIV infection should be suspected in any patient with OSSN who is younger than 50 years.

    OSSN typically arises in the interpalpebral limbal zone. It usually presents as a unilateral vascularized, gray, gelatinous limbal mass located medially or laterally in the sun-exposed interpalpebral fissure; the lesion may extend onto the peripheral cornea. Other features such as overlying leukoplakia (white plaque) and tortuous dilated “corkscrew” feeder vessels may be present (Figs 5-17, 5-18A, B). Clinical features overlap with those of other ocular surface lesions, making diagnosis of OSSN based solely on clinical assessment difficult. Other entities in the clinical differential diagnosis of OSSN include pannus, benign papilloma, pinguecula, pterygium, vitamin A deficiency, benign intraepithelial dyskeratosis, and nevus.

    Figure 5-16 Schematic representation of the degrees of ocular surface squamous neoplasia (OSSN). The first panel represents normal epithelium with a basement membrane (pink line). In conjunctival intraepithelial neoplasia (CIN), the deeper layers of the epithelium are replaced with disorganized, often atypical cells that are not maturing normally (dysplasia). Carcinoma in situ is full-thickness replacement of epithelium by dysplastic cells, with the basement membrane still intact. In invasive squamous cell carcinoma, note the invasion through the basement membrane into the stroma.

    (Courtesy of Patricia Chévez-Barrios, MD.)

    Anterior segment optical coherence tomography (AS-OCT), ultrasound biomicros-copy (UBM), and impression cytology (IC) are less invasive options for possible diagnosis of CIN and OSSN. AS-OCT imaging has been reported to correlate with histologic findings in distinguishing noninvasive and invasive OSSN (Fig 5-18C, D). However, these diagnostic techniques are not routinely used for this purpose, and biopsy remains the standard for accurate diagnosis of these entities.

    Conjunctival biopsy and handling of these specimens require special care and attention for accurate diagnosis of OSSN and evaluation of the margins of excision (see Chapter 3 for more information on specimen preparation). Histologically, the epithelium often demonstrates an abrupt transition to an area of hyperplasia, loss of goblet cells, loss of polarity (loss of normal maturation from basal to superficial layers), nuclear hyperchromatism and pleomorphism, and mitotic figures that may be atypical. Dyskeratosis, including surface keratinization (resulting in the clinical appearance of leukoplakia) and formation of keratin pearls within the epithelium, may be present. Often, there is chronic inflammation and increased vascularity in the underlying superficial stroma. Elastotic degeneration is also often present in the stroma (Fig 5-18E, F; see also Fig 5-17B).

    The most important histologic assessment in OSSN is determining whether the neoplasia is contained by the epithelial basement membrane (ie, intraepithelial or in situ) or whether neoplastic cells have breached the basement membrane and invaded the stroma (see Figs 5-17, 5-18). The term conjunctival intraepithelial neoplasia (CIN) is often used for lesions contained by the basement membrane. The neoplasia is graded as mild, moderate, or severe according to the degree of cellular atypia. In cases of the most severe dysplasia, there is full-thickness involvement of the epithelium, often with squamous eddies or keratin whorls or pearls (see Figs 5-17C, D and 5-18E). For full-thickness dyplastic lesions, the term squamous carcinoma in situ is used.

    Figure 5-17 Ocular surface squamous neoplasia (OSSN). A, Clinical photograph. Note the vascular tortuosity of the conjunctival portion and the gelatinous appearance with focal leukoplakia of the corneal portion. Also note the prominent feeder vessels. B, Histologic examination shows the sharp demarcation (arrow) between normal and abnormal epithelia in OSSN. The epithelium is hyperplastic, with surface keratinization (K). Because the basement membrane is intact and there is partial-thickness dysplasia of the epithelium, a diagnosis of CIN is made. There is a chronic inflammatory response in the stroma (CI). Also note areas of elastotic degeneration in the stroma (arrowheads), indicating that the lesion arose over a pinguecula. C, High magnification (image from a different patient) shows the transition zone where neoplasia begins (arrow). To the right of the arrow, the epithelium exhibits mild surface keratinization, hyperplasia, nuclear hyperchromatism and pleomorphism, goblet cell loss, altered cell polarity, full-thickness involvement, and mitotic figures (M). The basement membrane is intact (arrowheads), making this a squamous cell carcinoma (SCC) in situ. D, In SCC, tongues of epithelium violate the basement membrane and invade the stroma (arrows), with whorls of epithelial cells known as squamous eddies (arrowheads).E, Gross photograph of a large ocular surface squamous carcinoma that invaded the limbus and anterior chamber angle through a previous surgical incision (arrow).

    (Part A courtesy of Vahid Feiz, MD; parts B–E courtesy of George J. Harocopos, MD.)

    Figure 5-18 Noninvasive and invasive ocular surface squamous neoplasia (OSSN). A, Slit-lamp photograph of a superior limbal gelatinous, grayish lesion with vascularity and extension onto the cornea. B, Slit-lamp photograph of a temporal limbal gelatinous lesion with large feeder vessels and extension onto the cornea. C, Anterior segment optical coherence tomography (AS-OCT) image of the lesion depicted in part A, demonstrating epithelial thickening and hyperreflectivity consistent with OSSN; in addition, there is hyperreflectivity at the epithelial base (arrow), possibly suggestive of more superficial epithelial disease. D, AS-OCT image of the lesion depicted in part B, demonstrating epithelial thickening and hyperreflectivity as well as prominent subepithelial hyperreflectivity (arrow), possibly suggestive of deeper invasion. E, Histology of the lesion depicted in parts A and C, demonstrating moderate to severe epithelial dysplasia consistent with noninvasive OSSN. F, Histology of the lesion depicted in parts B and D, demonstrating superficially invasive squamous cell carcinoma consistent with invasive OSSN.

    (Reproduced with permission from Polski A, Sibug Saber M, Kim JW, Berry JL. Extending far and wide: the role of biopsy and staging in the management of ocular surface squamous neoplasia. Clin Exp Ophthalmol. 2019;47(2):193–200.)

    Invasion of the stroma by neoplastic cells is diagnostic of invasive SCC (see Figs 5-17D, E, and 5-18F). Invasion of the sclera or cornea with intraocular spread is an uncommon complication of invasive SCC that typically occurs at the site of a previous surgical procedure or in patients whose immune response is suppressed. In addition, mucoepidermoid carcinoma and spindle cell carcinoma, rare variants of conjunctival carcinoma, may demonstrate aggressive behavior, with higher rates of recurrence, intraocular spread, and orbital invasion. Although regional lymph node metastasis and distant metastasis are less common with conjunctival SCC than with squamous carcinomas of the skin or other sites, dissemination and death occur in a small percentage of cases.

    • Conway RM, Graue GF, Pelayes DE, et al. Conjunctival carcinoma. In: American Joint Committee on Cancer (AJCC). AJCC Cancer Staging Manual. 8th ed. Springer; 2017: 787–793.

    • Moyer AB, Roberts J, Olsen RJ, Chévez-Barrios P. Human papillomavirus-driven squamous lesions: high-risk genotype found in conjunctival papillomas, dysplasia, and carcinoma. Am J Dermatopathol. 2018;40(7):486–490.

    • Polski A, Sibug Saber M, Kim JW, Berry JL. Extending far and wide: the role of biopsy and staging in the management of ocular surface squamous neoplasia. Clin Exp Ophthalmol. 2019;47(2):193–200.

    Excerpted from BCSC 2020-2021 series: Section 4 - Ophthalmic Pathology and Intraocular Tumors. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.

  • Most Commented
    Loading, please wait...
    There are no comments available.
    Most Viewed
    Loading, please wait...
    Most Viewed content is not available.
  • The Academy Store
    2021 North Carolina Codequest (Recording)
    2021 Tennessee Codequest (Recording)
    2021 Multistate Codequest (Recorded Feb. 5)
    2021 Michigan Codequest (Recording)
    Focal Points 2020 Complete Set
    2021 Coding Coach: Complete Ophthalmic Coding Reference 
    2021 CPT: Complete Pocket Ophthalmic Reference
    2021 Retina Coding: Complete Reference Guide
    2021 Fundamentals of Ophthalmic Coding
    2021 CPT Professional Edition 
    2021 HCPCS Level ll Professional Edition
    2021 Coding Assistant: Cataract and Anterior Segment
    2021 Coding Assistant: Cornea
    2021 Coding Assistant: Glaucoma
    2021 Coding Assistant: Oculofacial
    2021 Coding Assistant: Pediatrics/Strabismus
    2021 Coding Assistant for Subspecialties 
    Recorded Webinar: 2021 Ophthalmology Coding Update
    Webinar: 2021 Ophthalmology Coding Update
    Ophthalmology Journal
    Ophthalmology Retina Journal
    Focal Points Member Benefit
    2021 ICD-10-CM for Ophthalmology: The Complete Reference 
    Conquering New E-M Documentation Guidelines for Ophthalmology
    2020-2021 Basic and Clinical Science Course Complete Set
    2020-2021 Basic and Clinical Science Course Residency Set
    2020-2021 Basic and Clinical Science Course, Section 01: Update on General Medicine
    2020-2021 Basic and Clinical Science Course, Section 02: Fundamentals and Principles of Ophthalmology
    2020-2021 Basic and Clinical Science Course, Section 03: Clinical Optics
    2020-2021 Basic and Clinical Science Course, Section 04: Ophthalmic Pathology and Intraocular Tumors
 
  • Contact Us
  • About the Academy
  • Jobs at the Academy
  • Financial Relationships with Industry
  • Medical Disclaimer
  • Privacy Policy
  • Terms of Service
  • Help
  • For Advertisers
  • For Media
  • Ophthalmology Job Center

OUR SITES

  • EyeWiki
  • International Society of Refractive Surgery

FOLLOW THE ACADEMY

Medical Professionals

  • Facebook
  • Twitter
  • LinkedIn
  • YouTube

Public & Patients

  • Facebook
  • Twitter
  • Instagram
  • YouTube

Museum of the Eye

  • Facebook
  • Twitter
  • Instagram
  • Trip Advisor
  • Yelp
© American Academy of Ophthalmology 2021