Ocular Surface Squamous Neoplasia

A Standard of Care Survey

Abstract

Purpose: 

To determine the current standard of care in the treatment of ocular surface squamous neoplasia (OSSN) with particular regard to topical chemotherapeutic agents including mitomycin C, 5-fluorouracil, and interferon-α2b.

Methods: 

A mail survey of the 325 physician members of the Ocular Microbiology and Immunology Group.

Results: 

The survey response rate was 38%, and the average number or cases of OSSN managed by respondents was 6.5 per year. A majority (54%) believed sufficient evidence existed to justify the use of mitomycin C in the treatment of OSSN, and fewer felt the published literature justified the use of 5-fluorouracil or interferon (11% and 21%, respectively). About one-half of responding physicians always perform a biopsy before institution of topical therapy. The reported use of topical chemotherapy as an adjunct to surgical excision increased with the size of the lesion; 45% of the respondents utilize topical therapy along with surgery for lesions greater than 8 mm in diameter.

Conclusion: 

The standard of care for the treatment of ocular surface squamous neoplasia appears to have shifted from surgery toward the use of topical chemotherapeutic agents as adjuncts to surgery or even as sole therapy, despite a paucity of long-term studies in the published literature. Longer-term observational studies and prospective masked and controlled studies are indicated to determine the optimal treatment(s) for squamous neoplasia of the ocular surface.