September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Treatment of nodular conjunctival squamous neoplasia at UCSF
Author Affiliations & Notes
  • Andrew Allen Kao
    Ophthalmology, UCSF, San Francisco, California, United States
  • Armin Afshar
    Ophthalmology, UCSF, San Francisco, California, United States
  • Bertil E Damato
    Ophthalmology, UCSF, San Francisco, California, United States
  • Footnotes
    Commercial Relationships   Andrew Kao, None; Armin Afshar, None; Bertil Damato, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 2409. doi:
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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)

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Abstract

Purpose : 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.

Methods : 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.

Results : 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.

Conclusions : 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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