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Mitomycin safe, effective for conjunctival, cornea squamous cell carcinoma

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PHILADELPHIA — Topical mitomycin C was a safe and effective therapy for conjunctival and corneal squamous cell carcinoma in a study here, even for extensive recurrent tumors.

With applications of the antimetabolite, all tumors showed complete regression with no recurrence during the study period.

Carol Shields and others here at Wills Eye Hospital conducted a prospective study on 10 eyes of 10 patients with extensive recurrent conjunctival and corneal squamous cell carcinoma. The patients received one drop of topical MMC 0.04% four times daily in the eye with the carcinoma. Treatment cycles were 1 week with medication, 1 week without. This was repeated until resolution of the malignancy was seen.

Patients ranged in age from 33 to 77. All patients had undergone a median of two previous conjunctival tumor resections, leading to the diagnosis of in situ squamous cell carcinoma in three cases and locally invasive squamous cell carcinoma in six cases. At presentation, the tumor involved the limbus and cornea in all 10 eyes, forniceal conjunctiva in three eyes and tarsal conjunctiva in one eye. Ocular exams were performed at 2 weeks and 1, 2, 4 and 6 months following treatment, then twice yearly.

After one to four cycles of medication, complete regression of the tumor was reported in all patients, leaving normal appearing epithelial surfaces. Visual acuity showed substantial improvement in two patients, remained stable in seven patients and substantially worsened in one patient. VA improvement was attributed to resolution of precorneal opacification induced by the carcinoma, and worsening was attributed to stromal scarring from previous surgery.

MMC-related side effects were transient, including conjunctival erythema and chemosis and punctate epithelial keratopathy. No long-term complications were seen.

The researchers advise ophthalmologists to be cautious in using MMC, as long-term effects on the surface of the eye, the adjacent eyelid and nasolacrimal structures have not yet been determined.

The study appears in the American Journal of Ophthalmology.