Microscopically controlled excision of conjunctival squamous cell carcinoma

Although surgical excision, with or without adjunctive cryotherapy, is an accepted method of managing conjunctival squamous cell carcinoma, histologically verified tumor-free surgical margins cannot be assured by excision alone. We used a tissue conservation method, an adaptation of the Mohs' micrographic technique for cutaneous tumors, to monitor the conjunctival tissue margins by histologic review at initial tumor excision. We treated 19 patients with squamous cell carcinoma of the conjunctiva by this technique. Lamellar sclerectomy was used if the deep tissue margin was positive for residual tumor cell after the first stage review. Adjunctive cryotherapy was utilized in one patient because the deep scleral margin remained positive after lamellar sclerectomy, and further excision was not possible. In all patients, the tumor-free conjunctival defect was allowed to heal by secondary intention. During six months to 60 months of follow-up, no recurrences were documented. The only complication encountered was conjunctival scarring with secondary restricted motility in one patient. We believe this method of tissue margin surveillance offers a high cure rate for the treatment of conjunctival squamous cell carcinoma.