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Joshua Jones, Sarah Alshami, Jason Sokol, Kiran Kakarala, Lisa Shnayder; Recurrent squamous cell carcinoma with orbital invasion in the setting of immunosuppression following organ transplants – Case Series. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3351.
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This is a case series reporting four cases of patients who presented with recurrent squamous cell carcinoma (SQCCA) with orbital invasion in the setting of immunosuppression following organ transplant. In transplant patients, eyelid SQCCA is more common than basal cell carcinoma due to immunosuppression, with a recurrence rate of approximately 50%. Orbital invasion is a rare but serious complication of SQCCA requiring exenteration and is more likely to occur if treatment is delayed. Patients on chronic immunosuppression develop more aggressive SQCCA compared to the immunocompetent population, resulting in a significant burden on the quality of life and overall survival.
Charts from a university teaching hospital were analyzed, after institutional review board approval, consisting of four patients who underwent surgical resection, some radical, for treatment of recurrent squamous cell carcinoma following immunosuppressive therapy for transplants between 2011 and 2016.
In our case series the average patient age was 62 years old, 2 were male and 2 were female. One patient was deceased at the time of retrospective review due to metastatic disease. Each patient had a different type of transplant such as heart, liver, kidney, or bone marrow. The average time at initial diagnosis of recurrent squamous cell carcinoma was 6.3 years following initiation of anti-graft medication (9 months - 11 years), which included cyclosporine, tacrolimus, or mycophenolate.
SQCCA is a significant cause of morbidity and mortality for patients on long term immunosuppression following otherwise successful transplants. In our case series of 4 patients, 50% required life saving radical surgical resection, including exenteration. Even with a successful surgery the rate of mortality is high given the extent of invasion. Our findings confirm what previous studies have shown, that these patients need to be monitored closely for signs of peri-orbital malignancy and treatment should not be delayed given the high rates of recurrence and tissue invasion.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Large right upper eyelid lesions which required exenteration following positive biopsy for squamous cell carcinoma.
Axial T1 CT with contrast showing the large heterogeneous mass along the right upper eyelid.
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