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Andrew Allen Kao, Armin Afshar, Bertil E Damato; Treatment of nodular conjunctival squamous neoplasia at UCSF. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2409.
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© ARVO (1962-2015); The Authors (2016-present)
Treatment for nodular conjunctival squamous carcinoma traditionally involves excision with wide safety margins, superficial lamellar sclerectomy, adjunctive cryotherapy, and topical chemotherapy and/or immunotherapy. Extensive surgery may result in vision-threatening side-effects and patient discomfort. One author (BD) has treated these patients with minimalist surgery, with 1-2 mm margins, adjunctive topical chemotherapy with 5-fluorouracil (5-FU) instead of cryotherapy, and adjunctive radiotherapy instead of lamellar scleral excision. We performed a retrospective chart review to evaluate treatment of conjunctival squamous neoplasia with this method at the ocular oncology service at UCSF.
Charts of patients seen between the dates of 6/1/2014 and 9/30/2015 were reviewed. Eleven patients with a clinical diagnosis of conjunctival squamous neoplasia were identified. There were 8 males and 3 females, with an average age of 65 years at the time of diagnosis. All patients underwent excisional biopsy of their conjunctival lesion with a minimalist no-touch technique, with primary conjunctival closure. Following healing of the surgical site, approximately 4 weeks after surgery, all patients were started on pulsed topical 1% 5-fluorouracil (5-FU) therapy (4x/day for 4 days, every 4 weeks, for 4 cycles). The primary outcome was presence of recurrence at any point during follow-up.
Six patients had a histologic diagnosis of invasive squamous cell carcinoma, and 5 had intraepithelial neoplasia. Mean follow-up time was 6.3 months (range 1-16 mo). None of the patients developed recurrence by the time of the latest follow-up visit. Three patients experienced side effects, which included itching, irritation, and a skin rash. Two patients found to have extensive invasion were also treated with adjuvant proton beam radiotherapy during their course of topical chemotherapy.
Minimalist excision of invasive or in situ conjunctival carcinoma, with adjuvant topical 5-FU, and with radiotherapy in selected cases, is effective in treatment of this disease, while minimizing patient discomfort and associated side effects. Larger studies with longer follow-up should be performed to further validate this use of this treatment protocol.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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