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C.S. Cohen, G.K. Klintworth, R. Vann, N.A. Afshari; Conjunctival Epithelial Tumors: A Retrospective Review of Histopathology, Management and Recurrence . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3784.
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Purpose: Pilot study to evaluate the response to different therapeutic approaches in the treatment of conjunctival epithelial tumors. Methods: A retrospective clinicopathologic review of patients with conjunctival tumors that had been diagnosed histopathologically at the Duke University Medical Center. Results: Of a potential 110 histopathologically confirmed conjunctival tumors detailed clinical records were only available for review from 30 patients. Male to female ratio was 4:1. Age range was from 38-95 years with a median of 64 years. The majority of patients were Caucasian (86%). Most of the lesions (77%) were located at the corneoscleral limbus. Histopathologic findings included conjunctival papilloma, intraepithelial neoplasia (CIN) (a spectrum of intraepithelial abnormalities that ranged from moderate-severe dysplasia to intraepithelial carcinoma), squamous cell carcinoma and mucoepidermoid carcinoma. The therapeutic procedures performed varied considerably depending on the preference of the clinician involved in patient care. Of the thirty cases studied, eight (27%) had positive surgical margins of resection following the initial excision. Five of these were re-treated with interferon, excision and superficial keratectomy with cryotherapy, adjunct radiotherapy, or a repeat excision and cryotherapy. None of these cases subsequently recurred. The remaining three were squamous cell carcinoma, which recurred within 5-36 months, with a mean of 16 months. Two of these squamous cell carcinomas had initially been treated with excision and cryotherapy, and one only with an excisional biopsy. Conclusions: This study illustrates some of the drawbacks of retrospective reviews, but it nevertheless underscores the importance of positive surgical margins of resection as a risk factor for recurrent disease.. It also stresses that a wide variety of different therapeutic approaches to conjunctival neoplasms have been used. Because of an inability to draw objective conclusions about the relative merits of the various methods of treatment there is a need for a prospective masked study to determine the best overall treatment for conjunctival epithelial tumors.
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