Chemotherapy Eye Drops For Malignant Conjunctival Tumors

pigmented tumor "melanoma" in the conjunctiva.
External photograph shows the pigmented tumor “melanoma” in the conjunctiva.

By Paul T. Finger, MD

Current treatments for conjunctival cancer has included surgical removal, removal with subsequent cryo-(freezing)-therapy, radiation therapy, and chemotherapy eye-drops. While most treatments have focused on avoiding large surgeries which may (in very severe cases) be associated with vision loss or loss of the eye, these decisions have been made with the knowledge that conjunctival cancers are serious. They can invade into the orbit (tissues around the eye), the sinuses, and the brain. Conjunctival melanomas and squamous carcinomas can also spread (metastasize) to other parts of the body. Because of high recurrence rates after standard treatments and the desire to avoid surgery, recent investigations have focused on topical chemotherapy “eye-drops.”

For a more detailed explanation of the risks and potential benefits of topical chemotherapy for conjunctival cancers, the editor suggests you obtain and read the referenced manuscripts.

After 28 days of topical MMC chemotherapy the tumor regressed.
After 28 days of topical MMC chemotherapy the tumor regressed.

Conjunctival Melanoma and PAM with Atypia

In 1993, Dr. Finger was the first to use mitomycin chemotherapy eye-drops to treat conjunctival melanoma and primary acquired melanosis. Since that time, it has become commonly and widely used throughout the world. It is currently used to reduce the tumor prior to surgical removal and with surgery for cases where there is too much normal tissue involved (too much for surgery and/or freezing (cryotherapy).

In addition, Dr. Finger discovered that topical interferon chemotherapy (Intron A) eye drops can be used to treat superficial conjunctival melanoma.

Topical chemotherapy eye drops can be used as primary treatment, as well as an addition to surgery and cryotherapy. Since almost all conjunctival tumors have different sizes, shapes and locations, your eye cancer specialist should know when and if you are a candidate for topical chemotherapy.

Squamous Conjunctival Neoplasia

Chemotherapy eye-drops have also been investigated as an alternative treatment of squamous conjunctival – corneal neoplasia. For more information consider reading the following manuscripts. Squamous Conjunctival Neoplasia

References

  1. Finger PT, Milner MS, McCormick SA. Topical chemotherapy for conjunctival melanoma. British Journal of Ophthalmology 77:751-3, 1993
  2. Frucht-Pery J, Pe’er J. Use of mitomycin C in the treatment of conjunctival primary acquired melanosis with atypia. The Archives of Ophthalmology 1996;114:1261-1264.
  3. Finger PT, Czechonska G, Liarikos S. Topical mitomycin C chemotherapy for conjunctival melanoma and PAM with atypia British Journal of Ophthalmology 82:476-9, 1998
  4. Finger PT, Sedeek RW, Chin KJ. Topical interferon alfa in the treatment of conjunctival melanoma and primary acquired melanosis complex. Am J Ophthalmol. 2008 Jan;145(1):124-129.
  5. Danapoulos ED, Danpoulous IE, Liarikos SB et al. Effects of urea treatment in malignancies of the conjunctiva and cornea. Ophthalmologica 178:198-203, 1979
  6. De Keizer RJW, de Wolff-Rouendaal, van Delft JL, et al. Topical application of 5-FU in premalignant lesions of the cornea, conjunctiva, and eye lid. Doc Ophthalmol 64:31-42, 1986.
  7. Frucht-Pery J, Rozenman Y. Mitomycin C treatment for conjunctival -corneal intraepithelial neoplasia: A multicenter experience. Ophthalmology 104:2085-2093, 1997
  8. Wilson MW, Hungerford JL, George SM, Madreperla SA. Topical mitomycin C for the treatment of conjunctival and corneal epithelial neoplasia. American Journal of Ophthalmology 124:303-311, 1997

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