Corneal and Conjunctival Tumours

Corneal and conjunctival tumours are malignant cancers that grow on the outer surface of the eye. The most common types of malignant conjunctival tumours are squamous cell carcinoma, malignant melanoma, and lymphoma. The good thing about these tumours is that problems can often be detected earlier than cancers hiding inside the eye, as the problem is often visible to the patient and family members. It is important that any “spot” on the surface of the eye be evaluated to be sure that there is not a malignancy there. 

Squamous cell carcinomas appear as a reddish or white spot on the surface of the eye.  It often has blood vessels surrounding it, and may be flat or elevated.  Squamous lesions rarely metastasize, but can invade over the area affecting vision and also can invade into the orbit and sinuses. Squamous lesions are very responsive to anti-cancer eye drops and often this can cure the problem.  Many of the medications to cure squamous lesions were pioneered here at Bascom Palmer Eye Institute.  An advantage to the topical therapy is that it treats the entire ocular surface.  Surgery is also a treatment options and is done as described above with removal and a freezing adjunct.

Malignant melanomas can start as a nevus (freckle) or can arise as newly formed pigmentation.  Any pigmented spot should be evaluated to be sure that it is not suspicious.  Melanomas are aggressive lesions and can metastasize. Malignant melanoma of the conjunctiva should be removed. Along with removal, a freezing treatment is also done (cryotherapy). After removal, some patients will need special anti-cancer eye drops to kill any possible “seeds”. 

Lymphoma of the conjunctiva often has a “salmon” coloured lesion often hiding on the surface of the eye but under the eyelid.  It can be a sign of systemic lymphoma or be confined to the conjunctiva. Lymphomas of the conjunctiva are confirmed by a biopsy, and then a work up is done to see if the problem is localized only to the eye.  If only on the eye, the usual treatment is external beam radiation.  If other parts of the eye are involved, then medications/chemotherapy is needed for the whole body. 

Tests

An eye cancer specialist can determine if you have an eye cancer by performing a complete clinical examination. The examination may include asking questions about your medical history, examining both eyes, the tumour, doing an examination of the tumour, photographs, ultrasound examination, and optical coherence tomography (OCT).  These imaging techniques can be very helpful in diagnosing the type of cancer that you may have and the extent of the problem.  In some cases, CT scan, MRI, and a referral to an oncologist are needed.  Sometimes a biopsy is needed, but in many cases our specialized examination and imaging can help provide the diagnosis so that treatment decision may be initiated. 

Treatments

Your doctor will recommend treatment based on your medical history and the findings from the eye examination. Malignant lesions of the cornea and conjunctiva need treatment, but benign lesions such as freckle (nevus) or a pterygium can be watched.  If there are any concerns, or changes in the usually benign lesions, then treatment can be started. In these cases, the OCT can help to detect malignant changes. 

Chemotherapy Eye Drops – Chemotherapy drugs are medicines that kill cancer cells.  There are several types of topical chemotherapy eye drops that can be very helpful in eradicating cancer of the conjunctiva and cornea.  It may be used to fully cure some squamous lesions potentially without surgery, and is also used sometimes in addition to surgery in those who undergo excisions.  It is especially helpful in the management of squamous cancers of the conjunctiva and cornea as it treats the whole ocular surface.  These medications can be given as eye drops and sometimes as injections around the eye.  Your doctor will determine which medication is best for your eye and your type of cancer. 

Cryotherapy – Cryotherapy is the use of low temperatures to treat disease. Cryotherapy is applied under local anaesthesia and usually used in conjunction with surgical removal. The goal of cryotherapy is to freeze the malignant tissues in order to kill the malignant cells Cryotherapy may be recommended for conjunctival or eyelid tumours.

Radiation – Some cancers require radiation to eliminate the lesion.  This may be done with a calculated directed dose onto the eye or special plaque placed on the eye.  Your doctor will determine if your type of cancer needs this treatment