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.

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 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

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

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

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

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

Results – Case Study Case Study: 46 year-old male who noted a lesion from 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.

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