Patients provided consent for publishing these photos with teaching purposes. A presentation is dealing with squamous cell carcinoma of the eyelid and the eye, with the emphasis on African scenario of transforming of ocular surface squamous neoplasia into a cancer. Treatment is discussed (including excisions, antimetabolites and eye amputations).

1. CONJUNCTIVAL
SQUAMOUS CELL
CARCINOMA

2. Squamous Cell Carcinoma of
Conjunctiva: Defnition
 Squamous cell carcinoma is a cancer
 That means it is a malignant tumor
 It is non-melanocytic
 It is epithelial
 It can be on the surface only (non-invasive)
 It can be invasive to the eyeball and
adnexa
(1)

3. Risk Factors for SCC
• Living closer to equator (exposure to
sunlight)
• More advanced stages and more
common in men
• Human papillomavirus type 16 (HPV 16)
• HIV (AIDS)
(9)

4. Squamous Cell Carcinoma:
Localization
 Eyelids
 Conjunctiva
 Cornea
 Orbit
(1)

5. Squamous Cell Carcinoma of the
Eyelid
 5-10% of all eyelid malignancies (second
after basal cell carcinoma in western
countries)
(1)

6. Squamous Cell Carcinoma of the
Eyelid
(1)

7. Squamous Cell Carcinoma of the
Eyelid
Actinic
keratosis is
often a
precursor of
SCC

8. Squamous Cell Carcinoma of the
Eyelid: Pathology
(1) Surface
ulceration
(2) Keratin
pearls in
large nests
of squamous
epithelium
(3) Isolated
nests of
malignant
cells
invading
dermis

9. Squamous Cell Carcinoma of the
Eyelid
(1)
 Biopsy and histopathology are required
most of the times prior to surgical
treatment
 Invasion of the dermis is the hallmark for
the histopathologic diagnosis of invasive
SCC
 Orbital invasion may be diagnosed with
imaging investigations

10. Squamous Cell Carcinoma of the
Eyelid: Prognosis
 Risk of metastatic dissemination is 1-21%
 Eyelid SCC is potentially fatal and
responsible for considerable morbidity
 Orbital invasion is a rare complication
that has been reported to occur in 2.5 %

11. (2)
Non-Invasive SCC of the
conjunctiva

12. (3)
Invasive SCC of the Conjunctiva

13. Invasive conjunctival SCC
(Pathology)
(1) – Carcinoma in
situ and displasia
(2) – Invasive nests
of cancer cells

14. Squamous Cell Carcinoma of the
Conjunctiva
 Risk of metastatic dissemination is very
low (0,5-3%)

15. Grading of Epithelial Precancerous
and Cancerous Lesions of the
Conjunctiva and Cornea
 Squamous cell carcinoma is not the only
possible diagnosis for the lesion like this
(4)

16. Grading of Epithelial Precancerous
and Cancerous Lesions of the
Conjunctiva and Cornea
Currently the proper diagnosis for any
precancerous or cancerous epithelial
lesion of the conjunctiva and cornea
before getting the results of histopathology
is OSSN
(Ocular Surface
Squamous Neoplasia) (5)

17. OSSN Defnition
Ocular Surface Squamous Neoplasia is
any epithelial precancerous or cancerous
lesion of the conjunctiva and cornea. This
is the only diagnosis we can make without
histopathology.
(6)

18. (7)
OSSN

19. OSSN Grading
OSSN can be graded into:
• Dysplasia
• Carcinoma in situ (CIS)
• Squamous cell carcinoma (SCC)
(8)

20. Frequency of OSSN
• 0,3 per million in USA
• 19 per million in Australia
• Much more common in countries with
bigger HIV prevalence
(10)

21. Clinical Signs
It is difficult to differentiate
between conjunctival epithelial
dysplasia, carcinoma in situ and
squamous cell carcinoma
clinically
(11)

22. AIDS and OSSN
HIV (AIDS) epidemics caused
increased incidence of OSSN
Check CD4 in each patient with
presumed OSSN
(12)

23. Diferential Diagnosis of OSSN
Pingueculas, Pterygia,
Squamous Papillomas
(13)

24. Pterygium and OSSN
(14)

25. Workup
(15)
Different types of cytology or
incisional / excisional biopsy
are needed to make proper
diagnosis

26. Workup
(16)
Check for most frequent
metastases: preauricular,
submandibular, cervical
lymph nodes, parotid gland,
lungs, bones

27. Treatment of OSSN
(17)
1st
: initiation of HAART if appropriate
(even invasive SCC may resolve)
2nd
: excision with safety margins (4
mm)
3rd
: antimetabolites
4th
: frequent reviews for recurrences

28. OSSN and Recurrences
(18)

29. Treatment of SCC
(19)
1st
: wide excision if possible
2nd
: eye amputation
3rd
: radiotherapy
4th
: frequent reviews for
recurrences

31. Conjunctival SCC amenable to
no-touch excision +/- 5-FU chemoreduction and
postoperative 5-FU treatment

33. Eye Amputations
(20)
• Evisceration
• Enucleation
• Exenteration

34. Enucleation

35. Enucleation

37. Exenteration
(21)

38. Exenteration: self-granulating
wound

39. Exenteration: orbital invasive SCC

40. Exenteration: orbital invasive SCC

41. Prognosis in Invasive Tumors
Invasion: conjunctival, scleral, corneal.
Longstanding cases: invasion into the eye
and orbit.
Metastases: regional lymph nodes (relatively
uncommon.
Death from metastatic disease is rare (1-2%)

42. Take Home Messages
(22)
• Do not forget to check regional lymph nodes
in patients with tumors
• Motivate patients with OSSN for early
treatment
• Avoid excision without antimetabolites
• Review patients post excision frequently
• Check for HIV/CD4 in all OSSN patients
• Do send for histopathology

43. Thank you