Abstract
Purpose :
Squamous cell carcinoma (SCC) is the most common conjunctival malignancy and sits at the far end of the spectrum of ocular surface squamous neoplasia (OSSN). Prior studies have investigated risk factors and treatment of OSSN with varying conclusions. This study aimed to examine the clinical findings and management of conjunctival SCC.
Methods :
A retrospective review of patients referred to the Ophthalmic Plastic Surgery Service at Mass Eye and Ear between 2015 and 2021 found to have biopsy-proven conjunctival SCC. Patient demographics, past medical history, diagnosis, and management were analyzed.
Results :
A total of 54 patients and 55 eyes were included. Thirty-three patients were male (61.1%) and 21 were female (38.9%) with a median age of 65 (interquartile range (IQR) 56-72). Most patients were White (n=49, 90.7%) with no smoking history (n=28, 51.9%). Most lesions were on the bulbar conjunctiva (n=34, 61.8%). Thirty-eight eyes (69.1%) were noted to have SCC in situ and 17 (39%) had invasive SCC. The majority of eyes were treated with some combination of topical therapy (n=34, 61.8%), surgical excision (n=51, 92.7%), and cryotherapy (n=34, 61.8%). Interferon (n=33, 97.1%) was the most common topical therapy used and was most often administered as neoadjuvant therapy (n=12, 21.8%). Thirteen patients had disease recurrence (23.6%) and there were no significant differences in recurrence rate amongst patients treated with surgical excision +/- topical therapy vs. surgical excision alone (30.3% vs. 14.3%, p=0.310) with a median time to recurrence of 8.2 months (IQR 4.9-9.6) and 3.4 (3.3-15.0), respectively (p=0.499). At 1 year, recurrence was 29.4% in the combination therapy group and 12.5% in the surgical excision group. Median follow-up time was 25 months (IQR 8-64).
Conclusions :
While surgical excision remains the first-line for treatment of conjunctival SCC, topical treatments have gained popularity as evidenced by this study. Topical interferon was the most commonly used topical agent in this study, and is known to be well-tolerated relative to 5-fluorouracil or mitomycin C, but its limited availability now limits the ophthalmologists’ armamentarium. Future studies are needed to better characterize the use of these various treatments to optimize outcomes and quality of life.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.