DIFFERENTIAL-DIAGNOSIS AND PROGNOSIS OF 1 12 EXCISED EPIBULBAR EPITHELIAL NEOPLASIAS

Background Epithelial tumors of the epibulbar conjunctiva are rare in northern Europe. There are no reliable clinical criteria to predict th e histological nature of the lesion. Even histologically proven malign ant tumors typically do not show ocular invasion or metastasis. Patien ts and methods From 1980 to 1993, 112 epithelial epibulbar tumors were classified in our ophthalmopatho-logical laboratory. Surgical managem ent of 50 papillomas (mean age 46+/-18 years, 58% males), 49 conjuncti val/corneal intraepithelial neoplasias (CIN) (28 mild, 21 severe) and 12 squamous cell carcinomas (mean age 63+/-13 years, 69% males) includ ed excisional biopsy (61%), with additional lamellar keratectomy (14%) , epithelial abrasion (10%), cauterisation (3%), cryotherapy (2%), exc imer laser ablation (2%). Other management regimes were lamellar kerat oplasty (2%), penetrating keratoplasty (2%), epithelial abrasion (2%). One eye with intraocular invasion of a mucoepidermoid carcinoma was e nucleated. Results Fifty five per cent of the papillomas were located at the caruncle or semilunar fold. Seventy eight percent of the papill omas had a pedunculated appearence. Two lesions involved the epibulbar conjunctiva as well as the opposite tarsal conjunctiva (''kissing pap illoma''). Eighty eight percent of CIN/carcinoma were located at the l imbus. The clinical differential diagnoses of CIN/carcinoma were squam ous cell carcinoma (26%), papilloma (18%), leukoplakia (10%), pinguecu la/pterygium (10%), dysplasia (8%), malignant melanoma (5%), trachoma (3%), chronic keratocon-junctivitis with corneal pannus (2%), ''granul oma'' (2%), non-pigmented naevus (2%). After a mean follow-up of 6.3 /- 3.5 years, 13% of the papillomas showed a local recurrence. After a mean follow-up of 4.8 +/- 3.7 years, there were 30% local recurrences of CIN/carcinoma (50% each in severe CIN and carcinoma, 9% in mild CI N). But there was no recurrence of CIN/carcinoma in patients who had r eceived a complete tumor resection initially. If the surgical margins were involved, there was a 64% recurrence rate (80% each in severe CM and carcinoma). Thirteen per cent of the patients with CIN/carcinoma s howed an additional malignant tumor elsewhere in the body. Conclusions Local recurrences after excision of CIN/carcinoma did occur only if t he surgical margins where involved, and most often within the first ye ar following surgery. Dedifferentiation of epithelial tumors in recurr ences was not observed. The diagnosis of CIN/carcinoma of the conjunct iva requires the exclusion of an additional extraocular neoplasia. His topathological classification and assessment of resection margins of e pibulbar tumors is indispensable, especially in view of the more aggre ssive treatment necessary in mucoepidermoid carcinomas.