gms | German Medical Science

Spot-like changes of the ocular surface caused by "white" color require clarification of the differential diagnosis by the ophthalmologist and not infrequently expertise of other medical disciplines.

If after detailed anamnesis, follow-up and interdisciplinary consultation the occurrence of a carcinoma in situ cannot finally be excluded, diagnostic excision is unavoidable to arrive at a reliable diagnosis. In such a case, the histopathological assessment can be a very valuable part of the diagnosis. While the ophthalmologist will have no difficulty in performing the conjunctival excision, the operation means "psychological" stress for the patient. So in some cases it may be helpful to make a cytological examination, e.g. impression cytology, before starting the diagnostic excision.

To demonstrate the clinical as well as histological and cytopathological findings in patients with the cardinal symptom of "leukoplakia". What is clinically termed "leukoplakia" should not be considered to be the same as a histological diagnosis. In differential diagnostic terms, this cardinal symptom should be considered under aspects of benign processes (Bitot's spots, keratoacanthoma, benign intraepithelial dyskeratosis, pseudo-epitheliomatous hyperplasia), precancerous (actinic keratosis, epithelial dysplasia) or cancerous changes (squamous cell carcinoma, mucoepidermoid carcinoma). Histopathologically, epithelial hyperplasia, acanthosis, hyper- and parakeratosis are observed. Criteria for the presence of malign processes would be increased keratinization, involvement of depth, irregular cell arrangement, nuclear pleomorphia or the increased occurrence of mitoses. The management of the leukoplakia on hand is discussed with reference to case studies.

Conclusion: Spot-like changes of the ocular surface due to "white" color which cannot be clearly diagnosed by the ophthalmologist or interdisciplinary approach should always be sent for pathomorphological assessment. Sampling must consider the special conditions and requirements of the sampling technique at the visual organ. The morphological examination is critical to the therapeutic plan.