What does the treatment involve?
Conjunctival tumour surgery involves removing the full tumour or a small part thereof, and performing a biopsy on the tissue to see if it is benign or malignant.
When is this treatment indicated?
This procedure may be performed for various reasons. It is indicated when there is a lesion that causes discomfort or redness or it is affecting the patient's appearance.
It is mainly indicated when the tumour specialist has seen a change in the size, colour or thickness of the conjunctival lesion or suspects malignancy. This happens frequently in pigmented conjunctival lesions and when there is family history of malignant tumours like melanoma.
How is it performed?
This procedure is generally performed under local anaesthetic with mild sedation and is an outpatients treatment. In paediatric cases, the procedure may be carried out under general anesthestic. Surgery is performed in sterile conditions with a surgical microscope.
Excisional surgery is carried out when the edges of the tumour are well defined. First, the surgeon marks the visible edges of the tumour, then a large margin far from the edges of the tumour to demarcate the whole area to be removed.
This is done to eliminate all the possible tumoral cells. In some cases, when there is suspected malignancy, cryotherapy is given to ensure all the small tumoral cells (invisible under a microscope) are destroyed.
The blood vessels coagulate given that the conjunctiva is a vascular tissue and the tumours themselves are even more vascular, meaning that there is a tendency toward bleeding during surgery.
The primary closing with fine sutures is perfomed to adhere the edges of the conjunctiva in place in the case of small tumours. When the tumour is big and the remaining conjunctiva cannot be adhered in place with sutures, an amniotic membrane is used to cover the removed area. Tissular adhesive or sutures are used set the amniotic membrane in the area to be covered.
An incisional biopsy is perfomed on tumours with poorly defined edges or multiple lesions that affect a very extensive part of the conjunctiva. A small sample of the central part of the lesion is taken and small incision is closed with sutures.
A “map biopsy” is performed when the tumour affects various areas of the conjunctiva. This means performing incisional surgery on various parts of the conjuctiva and sending the tissue for biopsy.
The surgeon labels and meticulously puts directional markers on the tissue samples and sends them to the pathologist. After approximately two weeks, a histopathological report is sent to the surgeon and the patient is informed of the results.
Regardless of whether the tumour is benign or malignant, the surgeon will inform the patient of the prognosis. If the tumour is malginant and the dissection margins are tumour-free then only thorough observation is required.
If there are tumoral cells in the dissection margins or the tumour is malignant, the surgeon may offer complementary treatment with local chemotherapy using interferons, Fluorouracil or Mytomicin.
When there is spreading to the orbit or it is associated with local recurrent or distant metastasis, the patient is referred to an oncologist for a more comprehensive treatment for malignant neoplasm. In any case, the ophthalmologist follows the patient closely to detect any possible recurrence of the tumour in the eye and takes action as a consequence.
Results
As explained before, the prognosis of each case depends on the histopathological report, which the surgeon explains to the patient. The cosmetic results are excellent when surgery and reconstruction are carried out properly.
Benign lesions do not usually reappear and only require regular check-ups. Malignant cases require closer monitoring as they do tend to reappear.
Possible risks
In any kind of surgical procedure, infection is a risk.
Another risk is tumour recurrence, especially in malignant cases and it may require complementary treatment like chemotherapy. Specially prepared eye drops or a perilesional injection can be used for this purpose.
In cases that the tumour has affected a very extensive area of the conjunctiva, including the limbus (transition area between the cornea and the conjunctiva-sclera), there may be a shortage of limbus stem cells. This may cause dry eye and discomfort that may require treatment with abundant lubrication or, in extrement cases, cell therapy with autologous serum.