SURGICAL-MANAGEMENT OF CONJUNCTIVAL TUMORS - THE 1994 LYNN-B.-MCMAHAN-LECTURE

To our knowledge, there are no articles that describe the specific ste p-by-step details of the surgical removal of premalignant and malignan t conjunctival tumors. We describe our current approach to the surgica l management of squamous cell carcinoma (intraepithelial or invasive), localized melanoma, and primary acquired melanosis of the conjunctiva . The surgical method differs with limbal tumors, extralimbal tumors, and primary acquired melanosis. Limbal lesions are managed by localize d alcohol corneal epitheliectomy, removal of the main mass by a partia l lamellar scleroconjunctivectomy, and supplemental cryotherapy. Tumor s located in the extralimbal conjunctiva are managed by alcohol applic ation, wide circumferential surgical resection, and cryotherapy. Prima ry acquired melanosis is managed by alcohol epitheliectomy, removal of suspicious foci, quadrantic staging biopsies, and cryotherapy from th e underside of the conjunctiva. In all cases, a ''no touch'' method is used and direct manipulation of the tumor is avoided to prevent tumor cell seeding into a new area, We have employed this technique on 109 patients with conjunctival squamous neoplasms and 137 patients with co njunctival melanoma, about 80 of which neoplasms were associated with primary acquired melanosis. Our observations suggest that well-planned initial surgical management using this technique decreases the chance of turner recurrence for conjunctival melanoma and squamous cell carc inoma. We describe a detailed stepwise approach to the surgical manage ment of conjunctival neoplasms. It requires meticulous clinical evalua tion and complete removal of the tuner in one operation using a specif ic technique.