Abstract
Purpose :
Squamous cell carcinoma (SCC) is the second most common cutaneous cancer following basal cell carcinoma (BCC). SCC of the conjunctiva represents the end stage of a spectrum of lesions called ocular surface squamous neoplasia, where invasion distinguishes it from conjunctival intraepithelial neoplasia. It usually presents as a slow-growing mass nasally in the interpalpebral fissure. Clinical diagnosis can be challenging as SCC of both the eyelid and conjunctiva have no pathognomonic features. Early detection is crucial to allow management with surgical excision rather than exenteration in advanced cases. This series intends to identify characteristic findings of SCC and underline the importance of maintaining a high degree of clinical suspicion for early detection and management.
Methods :
A total of 69 biopsies of patients of SCC were obtained from the MUHC – McGill University Ocular Pathology & Translational Research Laboratory between 2006 to 2023. All cases were reviewed histopathologically as well as the clinical characteristics of the patients, including age, sex, location, clinical and pathological diagnosis.
Results :
Of the 69 SCC cases, 19 were conjunctival, 37 were in the eyelid, 6 were periorbital (scalp, temple, lacrimal), and 7 represented orbital invasion. For conjunctival SCC, the median age was 70 years, with male predominance (63 %), left eye affected in 61%, 65% (n=11/17) being superficially invasive and 35% (n=6) invasive. Poorly differentiated SCC was found in 50% (n=4/8). There was concordance between clinical and pathological diagnoses in 53%. In eyelid SCC, the median age was 74 years, with female predominance (51%). The right eye was affected in 62% and the lower eyelids in 59%. The most common clinical diagnosis was BCC (32%), followed by SCC (21%). Well-differentiated SCC was found in 57% (n=8/14), and 55% (n=12/22) were superficially invasive, while 41% (n=9/22) were invasive. Clinical-pathological diagnosis concordance was 36%.
Conclusions :
To the best of our knowledge, this is the largest cohort of patients of SCC of the eyelid and conjunctiva. This study highlights the importance of early diagnosis and treatment, considering the invasiveness of this form of malignancy. Accurate clinical diagnosis is challenging, especially when it comes to differentiating malignant from benign lesions, and histopathology remains the gold standard for definitive diagnosis.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.