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    Ocular surface tumors require careful exam, consideration of best options

    Surgery versus topical chemotherapy poses risks, benefits for each patient

     

    3. Do not violate Bowman's membrane

    If opting for surgery, be careful not to violate Bowman’s membrane, which is a natural barrier against the tumor spreading in the cornea.

     

    4. Use cryotherapy as an adjuvant

    It is clear from the literature that not applying cryotherapy at the time of the initial surgery increases the risk of tumor recurrence. 

    For conjunctival melanoma, lack of cryotherapy also increases the risks of metastasis and death.

     

    5. Reconstruct the ocular surface with amniotic membrane

    “I’m a big fan of amniotic membrane,” Dr. Colby said. “You can take more uninvolved tissue around the tumor and still have a wonderful outcome.”

     

    6. Treat the entire patient 

    “I’ve treated many skin cancers just by looking at the patient before I sit down and turn the lights out,” she said. Encourage patients with ocular surface tumors to see a dermatologist for a skin evaluation

     

    7. Consider new technology to help with diagnoses

    Dr. Colby cited the work of Carol Karp, MD, of Miami, which has shown that high-resolution anterior segment OCT can help distinguish squamous lesions from amelanotic melanoma. She also praised Dr. Karp’s published reports in the area of ocular surface tumors and interferon. 

     

    Kathryn A. Colby, MD, PhD

    E: [email protected]

    This article was adapted from Dr. Colby’s presentation during Cornea Subspecialty Day at the 2016 meeting of the American Academy of Ophthalmology. She has no related disclosures.

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