Delhi Journal of Ophthalmology

Mitomycin C: An effective adjunct in the treatment of Ocular Surface Squamous Neoplasia

Neha Verma1, Qamar Jawaid2
1Department of Ophthalmology, Sardar Patel Hospital, Gorakhpur, U.P., India
2Department of Ophthalmology, Sant Parmanand Hospital, Civil Lines, New Delhi, India

Corresponding Author:

Qamar Jawaid MBBS, DOMS
436, Civil lines, Sardar Patel Hospital,
Chhatra Sangh Bhawan, Gorakhpur, UP - 273001
India
Email id: qamarj29@gmail.com

Received: 12-MAR-2019

Accepted: 30-JUL-2019

Published Online: 27-DEC-2019

DOI:http://dx.doi.org/10.7869/djo.488

Abstract
A 40 year old female patient presented with a mass in the right eye, foreign body sensation and redness in the right eye for 6 months. Examination revealed a mass in the interpalpebral area,located in the superonasal quadrant, involving the bulbar conjunctiva and cornea. The mass was papillomatous, having a strawberry appearance,with multiple feeder vessels and was sharply demarcated. Visual acuity in the right eye was 6/6p, with full range of ocular movements. The left eye with a visual acuity of 6/6p was normal. AS-OCT performed revealed hyper-reflectivity and a thickened epithelium in the right eye. Histopathological examination confirmed it to be an infiltrating squamous cell carcinoma with moderate differentiation. The lesion was subjected to a wide excision together with intra-operative Mitomycin C (MMC) used in a concentration of 0.04%. Two 1 week courses of topical MMC 0.04% were given post-operatively. The patient was examined at 6 monthly intervals and no recurrence has been observed till third follow-up.

Conclusion: Mitomycin –C is an effective adjuvant in the management of OSSN.


Keywords :Ocular surface squamous neoplasia, Paillomatous, Mitomycin-C, Recurrence

A 40-year-old female presented with complaints of a mass in the right eye, for 6 months. There were no systemic complaints.
Examination revealed a sharply demarcated, papillomatous mass with multiple feeder vessels in the interpalpebral area of right eye and was located in the superonasal quadrant, involving the bulbar conjunctiva and cornea (Figure 1). The best corrected visual acuity of the right eye was 6/6. Ocular movements were full and free. Gonioscopy performed did not reveal any intraocular invasion. Dilated fundus examination was also normal. The left eye was normal. An AS-OCT (Anterior Segment Optical Coherence Tomography) performed revealed hyper-reflectivity together with a thickened epithelium in the right eye.


A histopathological examination (was an incision biopsy performed) confirmed it to be an infiltrating squamous cell carcinoma with moderate differentiation (Figure 2).


The lesion was subjected to a wide excision together with intra-operative Mitomycin C (MMC) used in a concentration of 0.04%. Two 1 week courses of topical MMC 0.04% were given post-operatively four times a day, after complete epithelial healing.1 Each course was followed by 1 week free of MMC. The patient was examined at 6 monthly intervals and no recurrence has been observed till third follow-up (Figure 3).


Discussion OSSN though previously considered an uncommon entity, a number of reports have appeared in world literature in recent years.2 The most common risk factors include smoking and exposure to sunlight. The mainstay of treatment for OSSN has always been wide excision. Excision allows an immediate surgical debulking, histopathological diagnosis and excludes any form of invasive carcinoma.3 As per Kaines et al4 the disadvantage of primary excision alone is the high recurrence rate which ranges from 15% to 52%. Therefore, numerous adjunctive treatments have come up so as to decrease the rate of recurrence. These include intraoperative cryotherapy and brachytherapy and postoperative topical chemotherapy using mitomycin C, 5-FU, and interferon alpha-2b.5 We used MMC as there are no head-to-head studies that compare different drugs or schedules for adjuvant and/or primary treatment, the results of several studies show similar local control of the disease with MMC, 5-FU, and IFN.

Post operative MMC avoids repeat surgery and also treats the ocular surface, destroy subclinical disease, and prevent new tumors arising elsewhere on the ocular surface. Hence the use of MMC ensures a better surgical outcome and patient satisfaction.6

Conclusion

To conclude, Mitomycin C is an effective adjuvant in the management of OSSN.

References
  1. Wilson MW, Hungerford JL, George SM, Madreperla SA. Topical mitomycin C for the treatment of conjunctival and corneal epithelial neoplasia with topical mitomycin C. Am J Ophthalmol, 1997; 124:397–9.
  2. Hirst LW, Axelsen RA, Schwab I. Pterygium and associated ocular surface squamous neoplasia. Arch Ophthalmology, 2009; 127:31-2.
  3. Vann RR, Karp CL. Perilesional and topical interferon alfa-2b for conjunctival and corneal neoplasia. Ophthalmology, 1999; 106:91-7.
  4. Kaines A, Malhotra R, Selva D, et al. Conjunctival squamous cell carcinoma with perineural invasion. Arch Ophthalmol, (in press).
  5. Mirza E, Gumus K, Evereklioglu C, Arda H, Oner A, Canoz O, et al. Invasive squamous cell carcinoma of conjunctiva first misdiagnosed as pterygium: A clinicopathologic report. Eye contact lens, 2008; 34:188-90.
  6. Shields CL, Naseripour M, Shields JA. Topical mitomycin C for extensive, recurrent conjunctival-corneal squamous cell carcinoma. Am J Ophthalmol, 2002; 133:601–6.

Search PubMed for

CITE THIS ARTICLE

Verma N, Jawaid QMitomycin C: An effective adjunct in the treatment of Ocular Surface Squamous Neoplasia.DJO 2019;30:70-71

CITE THIS URL

Verma N, Jawaid QMitomycin C: An effective adjunct in the treatment of Ocular Surface Squamous Neoplasia.DJO [serial online] 2019[cited 2020 Jan 25];30:70-71. Available from: http://www.djo.org.in/articles/30/1/Mitomycin-C-An-effective-adjunct-in-the-treatment-of-Ocular-Surface-Squamous-Neoplasia.html