Conjunctival Biopsy - Squamous Cell Carcinoma and Dysplasia

Surgical Approach - In General

• These lesions often cross the limbus onto the cornea. When they do involve the cornea, they usually involve only the corneal epithelium.
• Do not perform lamellar dissections into the cornea to remove lesions that straddle the limbus. Bowman's layer is a natural barrier to the penetration of malignancies into the stroma and if the lesion recurs after Bowman's layer has been violated surgically, the recurrent lesion has unimpeded access to the stroma.

Surgical Approach - Specific Steps

• Balloon up the affected conjunctiva with anesthetic. If the lesion separates from the episclera after the injection, it is unlikely that the lesion has invaded the episclera.
• Dissect the lesion up to the limbus but do not dissect into the corneal stroma.
• Prepare the conjunctival biopsy for the pathologist, taking care to keep the specimen flat. Remember to tag margins appropriately. Click here to obtain hints on handling conjunctival biopsy specimens.
• If the corneal epithelium is involved, instill topical anesthesia. Then, moisten a cotton-tip applicator with absolute alcohol and gently wipe the diseased epithelium off. You may place the glob of epithelium onto a piece of filter paper and submit it for pathologic examination.

Severe conjunctival dysplasia (CIN III). The epithelium is thick, the architecture is disturbed, and mitotic figures were detected above the basal layer.

Ophthalmic Pathologists

Robert Folberg, MD, FCAP, Director

Deepak P. Edward, MD

Consultation Coordinator

Marnie Pomeroy