Coastal sun and wind make pterygium a familiar diagnosis in Malibu. A new systematic review asks how often tissue that looked like ordinary pterygium on the slit lamp turns out to harbor ocular surface squamous neoplasia (OSSN) under the microscope.
What the meta-analysis pooled
Investigators searched for studies through May 2024 that reported histopathology after surgery for clinically diagnosed pterygium. Twenty-one cross-sectional studies with 23,165 specimens from 22,921 patients met criteria. They also explored geography and skin-pigmentation patterns using study locations.
Pooled rates
- After excluding outliers, pooled prevalence of a non-pterygium diagnosis was about 3.8% (95% CI 1.9–5.8).
- Pooled prevalence of co-existing OSSN was about 3.7% (95% CI 1.8–5.7).
- Studies from regions with predominantly medium skin pigmentation reported higher co-existing OSSN (about 10.3%) than predominantly white (about 2.5%) or brown (about 3.1%) skin-type regions.
- Higher regional altitude was associated with higher OSSN prevalence in the regression analysis.
These percentages are averages across heterogeneous clinics. They do not mean every pterygium is cancerous. They do support sending excised tissue for pathology rather than discarding it.
Why histopathology changes the conversation
OSSN ranges from dysplasia to invasive squamous disease. Catching it on a specimen labeled “pterygium” can prompt closer margin review, topical chemotherapy discussions, or tighter follow-up than a routine pterygium plan. That is a different pathway from simply watching a fleshly growth for cosmetic reasons. Sunbelt and high-UV communities, including coastal Southern California, should treat pathology as routine stewardship, not an optional extra.
What I tell patients before pterygium surgery
- Atypical appearance—rapid growth, feeder vessels, leukoplakia, or unusual staining—raises suspicion before surgery.
- Ask whether your specimen will be sent to a pathologist.
- UV protection with hats and wraparound sunglasses remains the main prevention message after healing.
- Unexpected pathology results change follow-up; we coordinate with ocular surface or oncology specialists when needed.
Sun-exposed outdoor lifestyles are common in our coastal communities. For related reading on careful long-term eye monitoring, see encinolasik.com.
Source: Prevalence of ocular surface squamous neoplasia in clinically diagnosed pterygium specimens: A systematic review and meta-analysis (European Journal of Ophthalmology (PubMed PMID 42852915), 2026). This article is an educational summary written by Khanna Vision Institute and is not a substitute for medical advice.