R E V I E W Topical treatment options for conjunctival neoplasms Jonathan W Kim David H Abramson Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA Correspondence: Jonathan W Kim Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA Tel +1 212 639 7232 Email kimj12@mskcc.org Abstract: Topical therapies offer a nonsurgical method for treating conjunctival tumors by delivering high drug concentrations to the ocular surface. Over the past ten years, topical agents have been used by investigators to treat various premalignant and malignant lesions of the con- junctiva, such as primary acquired melanosis with atypia, conjunctival melanoma, squamous intraepithelial neoplasia and squamous cell carcinoma of the conjunctiva, and pagetoid spread of the conjunctiva arising from sebaceous cell carcinoma. Despite the enthusiasm generated by the success of these agents, there are unanswered questions regarding the clinical efﬁcacy of this new nonsurgical approach, and whether a single topical agent can achieve cure rates comparable with traditional therapies. Furthermore, the long-term consequences of prolonged courses of topical chemotherapeutic drugs on the ocular surface are unknown, and the ideal regimen for each of these agents is still being reﬁned. In this review, we present speciﬁc guidelines for treating both melanocytic and squamous neoplasms of the conjunctiva, utilizing the available data in the lit- erature as well as our own clinical experience at the Memorial Sloan-Kettering Cancer Center. Keywords: topical therapies, conjunctival neoplasms melanosis, Mitomycin-C, 5-Fluorouracil Introduction Historically, the established method of treatment for conjunctival neoplasms has been wide local excision, with or without supplemental cryotherapy to the surgical margins. Unfortunately, conjunctival neoplasms can be diffuse or multifocal, with borders that are difﬁcult to detect clinically or even with histopathologic examination. Topical therapies offer a nonsurgical method for treating the entire conjunctival surface with less dependence on deﬁning tumor margins. Topical administration can also deliver high drug concentrations to the ocular surface with negligible systemic side effects. Unlike surgical excision, topical treatments can be titrated and even repeated according to the clinical response. The cost is typically minimal when compared with surgical intervention, and there is little risk of spreading neoplastic cells with topical therapy. Because of these potential advantages, there has been growing interest in the use of topical agents for various conjunctival neoplasms. Over the past ten years, topical agents have been used by investigators to treat various premalignant and malignant lesions of the conjunctiva, such as primary acquired melanosis with atypia, conjunctival melanoma, squamous intraepithelial neoplasia and squamous cell carcinoma of the conjunctiva, and pagetoid spread of the conjunctiva arising from sebaceous cell carcinoma. Despite the enthusiasm generated by the success of these agents, it should be kept in mind that chemotherapeutic drugs can be potentially toxic to the ocular surface. There are also issues with compliance that do not exist with traditional therapies. The long-term consequences of prolonged courses of topical chemotherapeutic agents on the ocular surface are unknown, and the ideal regimen for each of these agents is still being reﬁned. Perhaps most importantly, there are unanswered questions regarding the clinical efﬁcacy of this new nonsurgical Clinical Ophthalmology 2008:2(3) 503–515 © 2008 Dove Medical Press Limited. All rights reserved 503