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Surgical Management of Ocular Surface Squamous Neoplasms: The Experience From a Cornea Center

Sudesh, Sudha M.D., F.R.C.Ophth.; Rapuano, Christopher J. M.D.; Cohen, Elisabeth J. M.D.; Eagle, Ralph C. Jr. M.D.; Laibson, Peter R. M.D.

Clinical Sciences

Purpose. To report the surgical outcomes of treatment for ocular surface squamous neoplasms.

Methods. Retrospective review of squamous neoplasms of the ocular surface managed at a cornea center over a 15-year period. Surgical treatment was divided into two methods. The procedure was identical within each group. One group of patients was treated with simple excision of the lesion. The second group of patients was treated with excision followed by focal cryotherapy to the involved limbus and/or conjunctival margin. Follow-up is reported.

Results. A total of 28 lesions were reviewed. Included were 20 primary tumors and 8 recurrent tumors referred following initial treatment at other centers. Histopathologic diagnoses included 1 actinic keratosis, 7 dysplasias, 18 carcinomas in situ, and 2 invasive squamous cell carcinomas. The rate of recurrence for primary tumors was 28.5% with simple excision and 7.7% for excision combined with cryotherapy (p = 0.27). The rate of recurrence for recurrent tumors was higher: 16.6% for tumors treated with excision and cryotherapy and 50% (one in two) for lesions treated with simple excision (p = 0.46).

Conclusion. Simple excision of ocular surface squamous neoplasms appears to result in a higher recurrence rate when compared to excision with adjunctive cryotherapy. Judicious cryotherapy to the involved limbus and conjunctival margins results in recurrence rates comparable with other, more extensive cryotherapy procedures. This technique of cryotherapy has very few adverse effects on the eye.

From the Cornea Service (S.S., C.J.R., E.J.C., P.R.L.), and the Department of Pathology (R.C.E.), Wills Eye Hospital, Philadelphia, Pennsylvania, U.S.A.

Submitted July 6, 1999.

Revision received October 9, 1999.

Accepted October 23, 1999.

Supported by the Corneal Research Fund and the Noel T and Sara L Simmonds endowment for ophthalmic pathology, Wills Eye Hospital.

Address correspondence and reprint requests to Dr. Christopher J. Rapuano, Cornea Service, Wills Eye Hospital, 900 Walnut Street, Philadelphia, PA 19107, U.S.A. E-mail: cjrapuano@hslc.org

© 2000 Lippincott Williams & Wilkins, Inc.