Microsurgical methods of tumor removal have prevailed in the management of ocular surface squamous neoplasia, but over the past decade, use of nonsurgical methods with topical chemotherapy, immunotherapy, antiviral medications, and even photodynamic therapy has increased. In this point-counterpoint presentation from the 2012 Annual Meeting, Dr. Carol Karp discusses the high recurrence rates associated with surgical therapy. Using Kaplan Meier, her study results were similar to Yousef and Finger: Higher American Joint Commission on Cancer classification tumors had higher risks of recurrence. Mitomycin C, 5-fluorouracil, and interferon have been effective in OSSN management. Medical therapy also has the theoretical advantage of treating the entire ocular surface and treating microscopic disease, and it can avoid stem-cell deficiency associated with extensive surgical excisions.