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    Ocular surface tumors require careful exam, consideration of best options

    Surgery versus topical chemotherapy poses risks, benefits for each patient

    Determining the best treatment for ocular surface tumors is not always easy, said Kathryn A. Colby, MD, PhD.

    As an example, Dr. Colby shared a challenging case of a healthy Caucasian woman in her early 50s who had an amelanotic conjunctival and corneal lesion for the past 7 years. The lesion had some recent growth. The patient had no personal or family history of malignancy.

    “We discussed at length the options, including what I consider the gold standard--surgical excision with cryotherapy and ocular surface reconstruction--versus preoperative chemotherapy to reduce the size of the tumor, especially with the large corneal component,” said Dr. Colby, the Louis Block Professor of Ophthalmology and Visual Science, and Chair, Department of Ophthalmology and Visual Science, The University of Chicago Medicine and Biological Sciences, Chicago.

    The patient opted to try topical chemotherapy with interferon alpha-IIb (1 million units four times a day).

    Per Dr. Colby’s usual protocol with topical interferon, she had the patient return at 4 to 6 weeks to see if the lesion had some response.

    “There was no issue with tolerability, but the lesion was larger, and there was now pigment on the surface,” Dr. Colby said.

    After surgery the following day, pathology examination revealed that it was a malignant amelanotic melanoma. Since surgery, the patient has done well.

    However, Dr. Colby believes the challenge with this case raises questions about the best management of ocular surface tumors. Some pearls include the following:

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