Combined topical 5‐Fluoruracil and extensive surgery in the management of corneo‐conjunctival squamous cell carcinoma

Purpose To evaluate safety and efficacy of combined neo‐adjuvant topical chemotherapy with 1%5‐Fluoruracil (1%5‐FU), followed by extensive surgery and adjuvant (post‐surgical) 1%5‐FU topical chemotherapy in the management of corneo‐congiuntival squamous cell carcinoma (SCC). Methods Twenty‐nine consecutive patients, with histological evidence of SCC, were included in this prospective study. Each patient was treated by combined neo‐adjuvant topical chemotherapy (1%5FU, four time daily for four week, 1 cycle), followed by extensive surgery (5 mm of free conjunctival surgical margins) with contemporary amniotic membrane reconstruction. Adjuvant topical chemotherapy was started 3 months after surgery (1%5‐FU, four time daily for four week, 1 cycle). Follow‐up was performed every 3 months for the first year and every 6 months thereafter, including clinical confocal microscopy. Follow‐up was longer than 36 months. Results Mean follow up was 56±11(range, 36‐78 years). Good functional, anatomic and aesthetic results were obtained by surgery. Two patients (5%) needed short‐term surgical amniotic membrane repositioning due to early sutures dehiscence. 1%5FU, used both as an adjuvant or neo‐adjuvant treatment caused low‐to‐mild temporary local irritation. No‐one patient discontinued therapy because of 5‐FU side effects. No other long‐ or short‐term side effects were documented. No local recurrences were documented during follow up. Conclusion Combined neo‐adjuvant topical chemotherapy with 1%5FU, extensive surgery and adjuvant 1%5FU topical chemotherapy appear a safe and effective combined treatment in the management of conjunctival SCC.