Patterns and factors associated with malignant conjunctival growths among adult patients with conjunctival growths attending eye clinic in Mulago National Referral Hospital

Abstract

Background: Conjunctival growths encompass a wide spectrum of lesions that can be benign, pre-malignant, and malignant tumors. Malignant conjunctival growths can cause visual loss, eyeball loss, or even death if not well managed. Conjunctival growth surgeries are the most common surgery in Mulago National Referral Hospital eye department; however, little is known about the patterns and factors associated with malignant conjunctival growths. General objective: To determine the patterns and factors associated with malignant conjunctival growths among adult patients attending the Eye Clinic at Mulago National Referral Hospital Methods: This was a quantitative, cross-sectional study conducted at Mulago National Referral Hospital (MNRH) Eye Clinic. Patients with conjunctival swellings were consented and recruited consecutively and Data was collected using a structured, pre-tested questionnaire and entered into EpiData 4.2 which was exported to STATA 17 for analysis. Descriptive statistics were presented as means, standard deviation (SD), frequencies, and proportions. Factors associated were assessed using logistic regression to obtain odds ratios with their corresponding P-values at a 95% confidence interval. Results: A total of 110 participants were included in this study. Their mean age was 49 (SD=+/-13) years. 29% of the conjunctival growths were malignant and the rest were non-malignant (benign and pre-malignant). Of the malignant growths encountered, the majority had Squamous Cell Carcinoma (SCC) at 90.6%, and 9.4% had conjunctival melanoma. Amongst those with SCC, most participants had carcinoma in situ (38%), followed by well-differentiated growths at 31%. All participants with conjunctival melanoma had pT1a pathological staging. White color (aOR:39.6, 95% CI=2.83-553.51), mixed color (aOR:17.6,95%CI=1.51-205.02), sub-epithelial involvement (aOR:1, 95%CI= 0.000-0.0237), Leucoplakia (aOR:1, 95%CI= 0.001-0.313), Pigmentation(aOR:0.3,95%CI=0.000-0.658) and having a rough texture (aOR:10.8,95% CI =1.23-94.51) were indicators of malignancy. Conclusion: The commonest malignant conjunctival growth was SCC followed by malignant conjunctival melanoma. Carcinoma in situ was the most common histological pattern while for conjunctival melanoma was the pT1a stage. Leucoplakia, pigmentation, rough texture, and sub-epithelial involvement were found to be highly associated with conjunctival malignancy.