Excision of ocular surface neoplasia with 2-mm margins yields low recurrence rates

Excision of ocular surface squamous neoplasia (OSSN) with a 2-mm margin does not lead to high rates of positive surgical margins, a recent study has found. For patients who do show positive margins, adjuvant topical therapy is enough to prevent recurrence.

Researchers conducted a retrospective chart review of 80 OSSN patients with histologically proven conjunctival intraepithelial neoplasia (CIN) and invasive squamous cell carcinoma. All patients received excision with a 2-mm margin and cryotherapy.

Assessment of tissue samples revealed that six patients (8 percent) had positive conjunctival margins after excision, four of whom needed postoperative topical therapy either with chemotherapeutic or immunotherapeutic agents.

Majority (n=69; 86 percent) of excisions led to negative conjunctival margins while the remaining five were classified as indeterminate.

Overall, there were three cases of recurrence. One occurred in the subgroup of patients with positive margins but was quickly resolved after initiating topical therapy. There was also one case each of recurrence in the subgroup with positive and indeterminate margins. The corresponding rates of recurrence were 17 percent, 1.5 percent, and 20 percent.

“Excision with 2-mm margin of CIN is not associated with high rates of positive surgical margins. While achieving low rates of local recurrence, the conjunctiva is conserved, thereby minimizing the need for amniotic membrane or free conjunctival grafts for conjunctival repair while preserving limbal stem cells,” the researchers said.

“If surgical margins are positive or indeterminate, adjuvant topical therapy should be considered,” they added.