Squamous Cell Carcinoma of Conjunctiva

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Invasive squamous cell carcinoma of conjunctiva is the major and most common ocular malignancy  of the eye. The tumor typically occurs on the bulbar conjunctiva, originating at the limbus, and often  spreads onto the cornea, globe, orbit and nasolacrimal system. The cancer is a slow growing tumor  of middle-aged to elderly people.  

Clinical presentation 

  • It manifests usually as a fleshy vascularized mass at the limbus. (temporal or nasally)
  • In advanced stage, it may intrude the eyeball and extend to other ocular adnexa structures
  • Definitive diagnosis is by histopathological assessment of excised tissue

Investigations 

  • Visual acuity
  • Slit lamp Bimicroscopy
  • Tonometry

Non-pharmacological Treatment 

  • Check for HIV status of the patient as recurrences occurs most frequently in HIV positive patients
  • Close  follow  up  of  patients  for  at  least  the  first  12  months  postoperatively  to  look  for residual or recurrent tumors

Pharmacological Treatment 

D: 5-fluorouracil (5FU) 50mg/mL, on a sponge, on the surgical bed for about 2.5minutes then wash off with compound sodium lactate solution.   

OR  

D: mitomycin C 0.2mg/mL, on a sponge, on the surgical bed for about 2.5minutes then wash off with compound sodium lactate solution. 

AND 

C: dexamethasone + chloramphenicol eye drops, 0.1%–0.5 %, 6hourly, for 3–4weeks 

OR 

C: dexamethasone + gentamicin eye drops, 0.1–0.3%, 6hourly, for 3–4 weeks (These are post operatively until the wound is healed) 

THEN 

D: 5-fluorouracil (5FU) 1% eye drops, 4times daily for 2–3weeks 

Note:  

  • 5-fluorouracil (5FU) is used after the excision wound has healed
  • 5  FU  eye  drops  may  cause  watery  eye,  discomfort  or  eye  inflammation,  manage accordingly

Surgical Treatment

  • It depends on the tumor size, location, focality, and invasiveness
  • Surgical  excision  of  the  mass  with  clear  margin  of  4  mm  without  touching  the  tumor  is recommended,  followed  with  topical  adjunctive  cryotherapy  and  or  chemotherapy  to  the residual conjunctival and scleral bed
    • Double    -    four freeze-thaw cycles of cryotherapy to the remaining conjunctival margins, bed and limbus.
    • For tumors that are adherent to the sclera, perform a superficial sclerectomy and use cryotherapy to the base.
  • A  large  or  multicentric  squamous  conjunctival  mass  should  be  managed  by  a  surgeon experienced in treating such lesions
  • Removal of the eyeball and adnexa may be indicated for advanced stage
  • Radiotherapy if required, for palliation after removal of the eye.

Referral: 

  • All suspicious cases of Squamous Cell Carcinoma of Conjunctiva must be referred to eye specialist for proper evaluation and management.
  • Refer  all  patients  with  advanced  Squamous  Cell  Carcinoma  of  the  conjunctiva  to Oncologist