# Conjunctival Squamous Cell Carcinoma: A Clinical Review of Diagnostic Features, Genetics, Current Management and an Update on Targeted and Immunotherapies

## TL;DR

This review discusses conjunctival squamous cell carcinoma, a rare eye cancer, focusing on its rising incidence, treatment challenges, and new immunotherapy approaches.

## Contribution

The paper provides a comprehensive clinical overview and highlights novel targeted and immunotherapies for conjunctival squamous cell carcinoma.

## Key findings

- The incidence of conjunctival squamous cell carcinoma is increasing globally, particularly in tropical regions.
- Immunotherapies like anti-PDL1 offer globe-sparing treatment options for advanced cases.
- Personalized treatment strategies integrating immunotherapy and targeted approaches are recommended for better outcomes.

## Abstract

Conjunctival squamous cell carcinoma (CSCC) is an eye surface cancer that can cause visual loss mortality. It is rare in temperate climates but is common in the tropics, particularly in India and Africa. Global number of new cases is on the rise. There is no standard treatment for CSCC, and management varies between eye cancer centres. This review aims to present current knowledge of CSSC development, clinical presentation, diagnosis, management and outcomes, and finally summarise novel therapies and future directions for research in CSCC. Immune checkpoint inhibitors, particularly anti-PDL1 therapies, offer a less invasive and globe sparing alternative for advanced SCC treatment. Future directions should focus on earlier detection and personalised approaches which integrate immunotherapy and other targeted treatments.

Invasive conjunctival squamous cell carcinoma (CSCC) is an aggressive, ocular surface malignancy. The mean annual age-standardised incidence rate of 0.45 cases per million per year is increasing with an average annual percent rise of 4.5% and occurs mainly in over 65-year-olds in temperate climates but in a younger demographic in the tropics. Invasive CSCC can lead to vision loss either from the destructive effects of the tumour or side effects of therapy, facial disfigurement from radical surgery, and death from metastases. There is no standardised treatment and not all cases are referred to a specialist ocular oncology centre. Recent progress in cancer immunology and genetics has revolutionised the treatment of cutaneous and head and neck SCCs, which share some similarities to invasive CSCC. A better understanding of invasive CSCC and its preinvasive intraepithelial lesions is required to lead to the development of novel targeted and immunotherapies both for local tumour control, globe sparing alternatives and to prevent disseminated disease. This review aims to provide a comprehensive clinical overview of the current knowledge regarding CSSC, its epidemiology, pathogenesis, presentation, diagnosis, management, recent advances in targeted and immunotherapies for personalised treatment of this disease, and early diagnosis strategies to improve patient outcomes.