The tissues superficial to the Bowman layer are removed easily in a single sheet and sent to the laboratory for analysis. Care should be taken not to incise into the Bowman membrane. Cryotherapy is performed, in a double freeze-thaw manner, to the edges of the uninvolved conjunctiva and Tenon capsule. It also can be applied to the involved limbal area. All excised tissues are submitted for histopathologic analysis.
Reconstruction is performed with direct closure, local flaps, or free conjunctival grafts.
Extensive lesions with orbital involvement require exenteration. Radiation therapy may be used as adjunctive therapy in cases of extensive lesions with poorly defined margins and as palliative therapy in cases where the patient cannot tolerate extensive surgery. An oncologist should be consulted if metastatic disease is suspected. Patients should be closely observed for any signs of recurrence. Recurrent lesions should be treated aggressively.