Purpose: To emphasize the importance of staging ocular surface squamous neoplasia when contemplating use of topical interferon alpha-2b alone. Cases: Two patients with 360 degrees of limbal involvement. Results: Two patients with in situ squamous cell carcinoma of the conjunctiva and clinical involvement of the entire limbus were treated with topical interferon alpha-2b. Thorough examination and multiple biopsies excluded invasive disease. The patients had complete response to therapy. Conclusion: Widespread intraepithelial squamous neoplasia involving the entire limbus can be successfully treated with topical therapies. Biopsy plays a role in excluding invasive disease. Interferon alpha-2b is a preferable agent to start with because it is well tolerated. Since long-term risks of recurrence are unknown, appropriate monitoring is essential.

1.
Lee GA, Hirst LW: Retrospective study of ocular surface squamous neoplasia. Aust N Z J Ophthalmol 1997; 25: 269–276.
2.
Shields CL, Demirci H, Karatza E, Shields JA: Clinical survey of 1,643 melanocytic and nonmelanocytic conjunctival tumors. Ophthalmology 2004; 111: 1747–1754.
3.
Dandala PP, Malladi P, Kavitha: Ocular surface squamous neoplasia (OSSN): a retrospective study. J Clin Diagn Res 2015; 9: NC10–NC13.
4.
Sun EC, Fears TR, Goedert JJ: Epidemiology of squamous cell conjunctival cancer. Cancer Epidemiol Biomarkers Prev 1997; 6: 73–77.
5.
Shields CL, Ramasubramanian A, Mellen PL, Shields JA: Conjunctival squamous cell carcinoma arising in immunosuppressed patients (organ transplant, human immunodeficiency virus infection). Ophthalmology 2011; 118: 2133–2137.
6.
Ramasubramanian A, Shields CL, Sinha N, Shields JA: Ocular surface squamous neoplasia after corneal graft. Am J Ophthlamol 2010; 149: 62–65.
7.
Sepulveda R, Pe’er J, Midena E, Seregard S, Dua HS, Singh AD: Topical chemotherapy for ocular surface squamous neoplasia: current status. Br J Ophthalmol 2010; 94: 532–535.
8.
Sherman MD, Feldman KA, Farahmand SM, Margolis TP: Treatment of conjunctival squamous cell carcinoma with topical cidofovir. Am J Opththalmol 2002; 134: 432–433.
9.
Ip MH, Coroneo MT: Treatment of previously refractory ocular surface squamous neoplasia with topical cidofovir. JAMA Ophthalmol 2017; 135: 500–502.
10.
Shields JA, Shields CL, De Potter P: Surgical management of conjunctival tumors. The 1994 Lynn B McMahan Lecture. Arch Ophthalmol 1997; 115: 808–815.
11.
Joag MG, Sise A, Murillo JC, Sayed-Ahmed IO, Wong JR, Mercado C, Galor A, Karp CL: Topical 5-fluorouracil 1% as primary treatment for ocular surface squamous neoplasia. Ophthalmology 2016; 123: 1442–1448.
12.
Frucht-Pery J, Rozenman Y: Mitomycin C therapy for corneal intraepithelial neoplasia. Am J Ophthalmol 1994; 117: 164–168.
13.
Maskin SL: Regression of limbal epithelial dysplasia with topical interferon. Arch Ophthalmol 1994; 122: 1145–1146.
14.
Carcinoma of the Conjunctiva; in Edge S, Byrd DR, Compton CC, Fritz AJ, Greene FL (eds): AJCC Cancer Staging Manual, seventh edition. New York, Springer International Publishing, 2010, pp 531–537.
15.
Kim HJ, Shields CL, Shah SU, Kaliki S, Lally SE: Giant ocular surface squamous neoplasia managed with interferon alpha-2b as immunotherapy or immunoreduction. Ophthalmology 2012; 119: 938–944.
16.
Hernandez-Bogantes E, Serna-Ojeda JC, Lichtinger A, Graue-Hernández EO: Interferon alpha-2b in giant ocular surface squamous neoplasia. Indian J Ophthalmol 2016; 64: 393–394.
17.
Zarei-Ghanavati S, Alizadeh R, Deng SX: Topical interferon alpha-2b for treatment of noninvasive ocular surface squamous neoplasia with 360° limbal involvement. J Ophthalmic Vis Res 2014; 9: 423–426.
18.
Margo CE, White AA: Ocular surface squamous neoplasia: terminology that is conceptually friendly but clinically perilous. Eye (Lond) 2014; 28: 507–509.
19.
Rudkin AK, Dempster L, Muecke JS: Management of diffuse ocular surface squamous neoplasia: efficacy and complications of topical chemotherapy. Clin Exp Ophthalmol 2015; 43: 20–25.
20.
Holcombe DJ, Lee GA: Topical interferon alfa-2b for the treatment of recalcitrant ocular surface squamous neoplasia. Am J Ophthalmol 2006; 142: 568–571.
21.
Shields CL, Kaliki S, Kim HJ, Al-Dahmash S, Shah, SU, Lally SE, Shields JA: Interferon for ocular surface squamous neoplasia in 81 cases: outcomes based on the American Joint Committee on Cancer Classification. Cornea 2013; 32: 248–256.
22.
Schechter BA, Koreishi AF, Karp CL, Feuer W: Long-term follow-up of conjunctival and corneal intraepithelial neoplasia treated with topical interferon alfa-2b. Ophthlamology 2008; 115: 1291–1296, 1296.e1.
23.
Kieval JZ, Karp CL, Abou Shousha M, Galor A, Hoffman RA, Dubovy SR, Wang J: Ultra-high resolution optical coherence tomography for differentiation of ocular surface squamous neoplasia and pterygia. Ophthalmology 2012; 119: 481–486.
24.
Jacinto FA, Margo CE: Clinically occult squamous cell carcinoma of conjunctiva after topical immunotherapy for ocular surface neoplasia. Can J Ophthalmol 2017; 52:e152–e153.
25.
Dudney BW, Malecha MA: Limbal stem cell deficiency following topical mitomycin C treatment of conjunctival-corneal intraepithelial neoplasia. Am J Ophthalmol 2004; 137: 950–951.
26.
Krilis M, Tsang H, Coroneo M: Treatment of conjunctival and corneal epithelial neoplasia with retinoic acid and topical interferon alfa-2b: long-term follow-up. Ophthalmology 2012; 119: 1969–1973.
27.
Moon CS, Nanji AA, Galor A, McCollister KE, Karp CL: Surgical versus medical treatment of ocular surface squamous neoplasia: a cost comparison. Ophthalmology 2016; 123: 497–504.
28.
Kaliki S, Singh S, Iram S, Tripuraneni D: Recombinant interferon alpha 2b for ocular surface squamous neoplasia: an efficient and cost effective treatment modality in Asian Indian patients. Indian J Ophthalmol 2016; 64: 702–709.
29.
Chitwood K, Etzkorn J, Cohen G: Topical and intralesional treatment for nonmelanoma skin cancer efficacy and cost comparisons. Dermatol Surg 2013; 39: 1306–1316.
30.
Besley J, Pappalardo J, Lee GA, Hirst LW, Vincent SJ: Risk factors for ocular surface squamous neoplasia recurrence after treatment with topical mitomycin C and interferon alpha-2b. Am J Ophthalmol 2014; 157: 287–293.e2.
31.
Tabin G, Levin S, Snibson G, Loughnan M, Taylor H: Late recurrences and the necessity for long-term follow-up in corneal and conjunctival intraepithelial neoplasia. Ophthalmology 1997; 104: 485–492.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.