• Cornea/External Disease

    This retrospective study evaluated clinical and histopathologic factors of squamous conjunctival neoplasia associated with recurrence in 99 patients (101 eyes). The authors found that advanced American Joint Committee on Cancer Classification (AJCC)-stage, locally invasive tumors and more pathologically aggressive tumors were at higher risk for recurrence. Inadequate initial therapy also was an important risk factor for recurrence. The authors conclude that tumor staging at presentation should affect treatment strategies.

    Researchers staged tumors according to the seventh edition of the AJCC staging system. This allowed for standardized comparison of methods of both diagnosis and treatment, and for standardized collection of information regarding the histopathologic diagnosis, tumor size, local invasion, lymph node involvement and distant metastasis.

    Recurrences were seen in 12.9 percent, with 92.3 percent occurring six to 12 months after primary treatment. Recurrence was not correlated significantly with age, gender, laterality, clinical appearance or focality of the tumor at presentation. However, tumors larger than 5 mm in diameter, those extending more than 2 mm onto the cornea and those with local invasion (corneal, scleral, intraocular or orbital invasion) were associated with a higher risk of recurrence.

    Increasing AJCC T-stage was correlated strongly to the incidence of recurrence (P = 0.0006). Rates were 1.7 percent for Tis-staged tumors, zero percent for T1- and T2-staged tumors, 34.3 percent for T3-staged tumors and 50 percent for T4-staged tumors. None of the tumors defined histologically as dysplasia showed recurrence, whereas 12.8 percent of carcinoma in situ tumors and 22.2 percent of squamous cell carcinoma tumors recurred.

    The authors note that the recurrence rate for tumors treated primarily at the authors' center was 4 percent, significantly less than the recurrence rate in previously operated tumors (P = 0.0003). This suggests that patients primarily treated by a general ophthalmologist may fare worse than those treated by an ophthalmic oncologist. This may be due to inadequate primary treatment, inadvertent invagination of tumor tissue, difficulty related to the specialist selecting the best secondary treatment without an initial tumor assessment, a selection bias toward referring advanced tumors or a combination of the above. Therefore, future care could be aided by initial slit lamp photography of the tumor and all conjunctival surfaces prior to initial biopsy or resection.

    These results, the authors write, suggest the need for more aggressive treatment for tumors in advanced stages. However, they also suggest that tumors with corneal extension should not be given the same stage as sclera-invading tumors because of the latter’s higher rate of recurrence. They conclude that AJCC staging was helpful in this analysis and will allow others to compare their scientific results with those presented in this study.