eMedicine Specialties > Ophthalmology > Conjunctiva

Squamous Cell Carcinoma, Conjunctival: Differential Diagnoses & Workup

Author: Christopher DeBacker, MD, Volunteer Faculty, Department of Ophthalmology, California Pacific Medical Center; Consulting Staff, Ophthalmic Medical Associates
Coauthor(s): Robert M Dryden, MD, FACS, Clinical Professor, Department of Ophthalmology, University of Arizona School of Medicine
Contributor Information and Disclosures

Updated: Feb 7, 2008

Differential Diagnoses

Burns, Chemical
Dermoid, Limbal
Melanoma, Conjunctival
Pterygium

Other Problems to Be Considered

Pseudocancerous lesions - Pseudoepitheliomatous hyperplasia and keratoacanthoma
Conjunctival degeneration - Pinguecula and amyloidosis
Papillomas - HPV-induced papillomas
Cancerous lesions - Sebaceous cell carcinoma, basal cell carcinoma, and rhabdomyosarcoma
Congenital tumors - Dermoids, dermolipomas, and episcleral osseous choristoma
Neuroectodermal tumors - Nevus, primary acquired melanosis, and melanoma
Lymphoid tumors - Lymphoid neoplasia, benign reactive lymphoid hyperplasia, and leukemic infiltrates
Xanthomatous lesions -Juvenile xanthogranuloma and fibrous xanthoma
Hereditary lesions - Benign hereditary intraepithelial dyskeratosis
Vascular lesions - Angioma, lymphangioma, Kaposi sarcoma, and pyogenic granuloma

Workup

Laboratory Studies

  • Once there is a suspicion of conjunctival squamous cell carcinoma, excisional biopsy is the treatment of choice.
  • For extremely large lesions, incisional biopsy may be performed; however, strict notation of the biopsy site and minimal handling of the surrounding tissues is imperative to prevent seeding of the tumor.
  • Recurrence rates as high as 50% are common for incompletely excised tumors.

Imaging Studies

  • Assess any suspicion of intraocular invasion with echography.
  • Assess any suspicion of orbital involvement with orbital imaging studies, preferably MRI with IV contrast enhancement.

Histologic Findings

Most squamous cell carcinomas have a gelatinous surface on gross inspection, which frequently is permeated by fibrovascular cores, giving it a papillomatous appearance.

On histologic examination, the full thickness of the epithelium is replaced by atypical, pleomorphic epithelial cells. The involved epithelium is typically 2-3 times thicker (acanthosis) than the normal adjacent epithelium. The normal polarity of the epithelial layers is lost (atypia), and mitotic figures are often present. By definition, the epithelial basement membrane layer is invaded by malignant cells, with involvement of the subepithelial tissues, and possibly adjacent eye, eyelids, and orbit. Metastasis, although rare, may occur.

More on Squamous Cell Carcinoma, Conjunctival

Overview: Squamous Cell Carcinoma, Conjunctival
Differential Diagnoses & Workup: Squamous Cell Carcinoma, Conjunctival
Treatment & Medication: Squamous Cell Carcinoma, Conjunctival
Follow-up: Squamous Cell Carcinoma, Conjunctival
Multimedia: Squamous Cell Carcinoma, Conjunctival
References
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References

  1. Akpek EK, Polcharoen W, Chan R, Foster CS. Ocular surface neoplasia masquerading as chronic blepharoconjunctivitis. Cornea. May 1999;18(3):282-8. [Medline].

  2. Erie JC, Campbell RJ, Liesegang TJ. Conjunctival and corneal intraepithelial and invasive neoplasia. Ophthalmology. Feb 1986;93(2):176-83. [Medline].

  3. Fraunfelder FT, Wingfield D. Management of intraepithelial conjunctival tumors and squamous cell carcinomas. Am J Ophthalmol. Mar 1983;95(3):359-63. [Medline].

  4. McKelvie PA, Daniell M, McNab A, Loughnan M, Santamaria JD. Squamous cell carcinoma of the conjunctiva: a series of 26 cases. Br J Ophthalmol. Feb 2002;86(2):168-73. [Medline].

  5. Pe'er J. Ocular surface squamous neoplasia. Ophthalmol Clin North Am. Mar 2005;18(1):1-13, vii. [Medline].

  6. Robinson JW, Brownstein S, Jordan DR, Hodge WG. Conjunctival mucoepidermoid carcinoma in a patient with ocular cicatricial pemphigoid and a review of the literature. Surv Ophthalmol. Sep-Oct 2006;51(5):513-9. [Medline].

  7. Shields CL, Demirci H, Marr BP, Masheyekhi A, Materin M, Shields JA. Chemoreduction with topical mitomycin C prior to resection of extensive squamous cell carcinoma of the conjunctiva. Arch Ophthalmol. Jan 2005;123(1):109-13. [Medline].

  8. Shields JA, Shields CL, De Potter P. Surgical management of conjunctival tumors. The 1994 Lynn B. McMahan Lecture. Arch Ophthalmol. Jun 1997;115(6):808-15. [Medline].

  9. Shields JA, Shields CL, Gunduz K, Eagle RC Jr. The 1998 Pan American Lecture. Intraocular invasion of conjunctival squamous cell carcinoma in five patients. Ophthal Plast Reconstr Surg. May 1999;15(3):153-60. [Medline].

  10. Tunc M, Char DH, Crawford B, Miller T. Intraepithelial and invasive squamous cell carcinoma of the conjunctiva: analysis of 60 cases. Br J Ophthalmol. Jan 1999;83(1):98-103. [Medline].

  11. Yeatts RP, Engelbrecht NE, Curry CD, Ford JG, Walter KA. 5-Fluorouracil for the treatment of intraepithelial neoplasia of the conjunctiva and cornea. Ophthalmology. Dec 2000;107(12):2190-5. [Medline].

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Further Reading

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Keywords

conjunctival squamous cell carcinoma, squamous cell carcinoma of the conjunctiva, conjunctival intraepithelial neoplasia, CIN, SCC

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Contributor Information and Disclosures

Author

Christopher DeBacker, MD, Volunteer Faculty, Department of Ophthalmology, California Pacific Medical Center; Consulting Staff, Ophthalmic Medical Associates
Christopher DeBacker, MD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Ophthalmology, American Society of Ophthalmic Plastic and Reconstructive Surgery, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Coauthor(s)

Robert M Dryden, MD, FACS, Clinical Professor, Department of Ophthalmology, University of Arizona School of Medicine
Robert M Dryden, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Cosmetic Surgery, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Ophthalmology, American College of Surgeons, American Society of Ophthalmic Plastic and Reconstructive Surgery, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Jerre Freeman, MD, Founder, Chairman, Memphis Eye and Cataract Associates; Clinical Professor, Department of Ophthalmology, University of Tennessee Health Science Center
Jerre Freeman, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, and Tennessee Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Hospital
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, Eye Bank Association of America, Pennsylvania Medical Society, and Philadelphia County Medical Society
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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