Mark Dacey MD, Brian Sullivan MD, Mark Dacey MD, Brian Sullivan MD,

and Steven Verity MDand Steven Verity MD

University of Texas Southwestern Medical Center University of Texas Southwestern Medical Center

and VA Medical Center, Dallas, TXand VA Medical Center, Dallas, TX

None of the authors have financial interest in the subject matter of this poster.None of the authors have financial interest in the subject matter of this poster.

Purpose

To investigate the efficacy and safety of topical Mitomycin C (MMC) as a treatment of ocular surface neoplasia after initial excisional biopsy and cryotherapy.

Introduction

Squamous cell carcinoma (SCC) of the conjunctivaSlow-growing neoplasm of dysplastic squamous

epitheliumFinely vascularized lesionsGelatinous thickening that can progress to

leukoplakiaCommonly spreads circumferentially around the

limbusLesions may extend onto the cornea or into the

visual axis

IntroductionTreatment Options

Excision with 1-2 mm margins and cryotherapy often result in limbal stem cell loss, particularly when six clock hours of the limbus or greater are involved

Epithelial debridement may have similar side effectsTopical Mitomycin C

Recently established as a first-line treatment for SCC following excisional biopsy

Adjunctive treatment to prevent recurrence while maintaining limbal stem cell integrity

Materials and MethodsRetrospective chart review of nine patients from

the Aston Center (Dallas, TX) and the Dallas VA Medical Center

DemographicsSeven males, two femalesAverage age 75 years

Seven patients with primary SCC and two with recurrent lesions Primary lesions treated with excisional biopsy and

cryotherapyRecurrent lesions not treated

Materials and MethodsPathology

Three patients with invasive SCCSix patients with SCC in situ or moderate to severe

dysplasiaTreatment regimen:

One week cycles of topical MMC 0.02% in methylcellulose four times daily

Treatment started 2-3 weeks after excision to allow for re-epithelialization

Topical artificial tears four times daily in the intervening weeks between cycles of MMC

Duration determined by clinical response, ranged from two to four cycles

Weekly observation

ResultsComplete tumor remission in all nine

patientsZero recurrences Follow-up over two years in five patientsTopical MMC well tolerated

Seven of the nine patients had no side effectsOne patient noted conjunctival hyperemia,

another noted mild eyelid erythemaAll patients tolerated the full clinical course

Results – Case Study

Case Study: 46 year-old male who noted a lesion from 7 - 12 o’clock and 3 mm onto cornea. Patient underwent biopsy with incomplete resection, followed six weeks later by complete excision and cryotherapy. Three years later, he was noted to have this recurrent lesion from 4-9 o’clock.

Results – Case Study

Case Study: Same lesion after one week course of topical Mitomycin C four times daily and one week of artificial tears four times daily. Note small nests of residual tumor.

Results – Case Study

Case Study: Same patient following three cycles of topical Mitomycin C four times daily. Note clinical absence of lesion.

DiscussionTreatment of ocular surface squamous cell

carcinoma with topical MMC after primary surgical excision has been demonstrated to be both efficacious and well-tolerated in this study of nine patients

Minimizes the morbidity associated with limbal stem-cell deficiency after wide local excision

Similar case reports in literatureFurther investigation with a large-scale trial

may be warranted to power these conclusions