Abstract

DO.08.08

Squamous cell carcinoma/CIN of the conjunctiva of the eye: Therapy and prognosis

Anke Tomaszewski1, Shahla Rahgozar1, Henrike Westekemper1, Nina Niederdräing1, Christopher Mohr2, Carsten Krüger2, Maurice Schallenberg1, Norbert Bornfeld3, Klaus-Peter Steuhl1, Daniel Meller1
1Klinik für Erkrankungen des vorderen Augenabschnittes, Zentrum für Augenheilkunde, Universitätsklinikum Essen, Essen, 2Mund-Kiefer-Gesichtschirurgie, Kliniken Essen-Mitte, Huyssens-Stiftung, Essen, 3Abteilung für Erkrankungen des hinteren Augenabschnittes, Zentrum für Augenheilkunde, Universitätsklinikum Essen, Essen

Objective
The squamous cell carcinoma or its preliminary stage the conjunctival intraepithelial neoplasia (CIN) are the most common malignant diseases of the eye. There are various therapies described for the treatment of these tumours like tumour resection, cryocoagulation or an adjuvant treatment with Mitomycin C or Interferon alpha 2b eye drops as well as radiation.
Methods
Forty Patients (47 eyes) with invasive squamous cell carcinoma (24 eyes) or CIN (23 eyes) were included in this retrospective study.
Results
The average follow up was 23.8 months. Patients were at the age of 61.2 ± 13.8 when the initial diagnosis was confirmed. Fifty-five % of those patients whose tumours had been removed completely (first diagnosed as squamous cell carcinoma) remained tumour free without any further intervention whereas 44.4 % developed relapses. Sixty-six % of those patients with remnant CIN after surgery (wide excision was impossible) developed recurrences. After an adjuvant treatment with Mitomycin C and/or Interferon alpha 2b eye drops 25 % of the patients had recurrences and in 50 % a downgrading of CIN was achieved.
With some of those patients who were diagnosed with CIN III but had not yet developed invasive carcinoma a wide excision was impossible due to tumour localization or latitude. Without adjuvant therapy 66 % of these patients developed squamous cell carcinoma whereas 33 % of these patients showed no tumour progression. After treatment with Interferon alpha 2b and/or Mitomycin C a downgrading of CIN was achieved in 33 % of the cases, with 50 % of the cases the disease was stabilized and 16 % developed squamous cell carcinoma.
Conclusions
Wide excision is the gold standard in treating squamous cell carcinoma/ CIN of the conjunctiva. In addition to that an adjuvant treatment with Interferon alpha 2b or Mitomycin C may help to reduce relapses and stabilize the tumour.   

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