Tissue Sparing Strategy in the Treatment of Ocular Surface Neoplasia Using Topical Mitomycin C

1
Tissue Sparing Strategy in the Treatment of
Ocular Surface Neoplasia Using Topical Mitomycin
C

• Mark Dacey MD, Brian Sullivan MD,
• and Steven Verity MD
• University of Texas Southwestern Medical Center
• and VA Medical Center, Dallas, TX
• None of the authors have financial interest in
  the subject matter of this poster.

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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.

3
Introduction

• Squamous cell carcinoma (SCC) of the conjunctiva
• Slow-growing neoplasm of dysplastic squamous
  epithelium
• Finely vascularized lesions
• Gelatinous thickening that can progress to
  leukoplakia
• Commonly spreads circumferentially around the
  limbus
• Lesions may extend onto the cornea or into the
  visual axis

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Introduction

• Treatment 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
  effects
• Topical 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

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Materials and Methods

• Retrospective chart review of nine patients from
  the Aston Center (Dallas, TX) and the Dallas VA
  Medical Center
• Demographics
• Seven males, two females
• Average age 75 years
• Seven patients with primary SCC and two with
  recurrent lesions
• Primary lesions treated with excisional biopsy
  and cryotherapy
• Recurrent lesions not treated

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Materials and Methods

• Pathology
• Three patients with invasive SCC
• Six patients with SCC in situ or moderate to
  severe dysplasia
• Treatment 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

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Results

• Complete tumor remission in all nine patients
• Zero recurrences
• Follow-up over two years in five patients
• Topical MMC well tolerated
• Seven of the nine patients had no side effects
• One patient noted conjunctival hyperemia, another
  noted mild eyelid erythema
• All patients tolerated the full clinical course

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Results Case Study
Case Study 46 year-old male who noted a lesion
from 7 - 12 oclock 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 oclock.
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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.
10
Results Case Study
Case Study Same patient following three cycles
of topical Mitomycin C four times daily. Note
clinical absence of lesion.
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Discussion

• Treatment 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 literature
• Further investigation with a large-scale trial
  may be warranted to power these conclusions