eMedicine Specialties > Ophthalmology > Conjunctiva

Squamous Cell Carcinoma, Conjunctival: Follow-up

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

Follow-up

Further Outpatient Care

  • Patients should be closely observed for any signs of recurrence.
  • Recurrent lesions should be treated aggressively. Occasionally, pyogenic granulomas can occur soon after tumor excision in areas of bare sclera. They typically respond quickly to topical steroid treatment and must be differentiated from recurrent tumor.
  • Evaluation by the patient's internist is prudent because of the possibility of metastasis.
  • Success in treating recurrences with topical mitomycin C drops has been reported.

Complications

  • The primary complication is recurrence, which typically occurs within the first year after excision but may occur much later. Intraocular invasion has been demonstrated in 2-8% of cases. Orbital invasion has been reported in 12-16% of cases.
  • Poor conjunctival and/or corneal healing may occur, especially if aggressive keratectomy, sclerectomy, or 100% ethanol application were performed. Symblepharon formation is a common surgical complication following tumor resection and ocular surface reconstruction.
  • Limbal stem cell damage may result from excision of large lesions

Prognosis

  • The prognosis is reasonably good for completely excised lesions. Various mortality rates have been reported; some reported rates are as high as 4-8%. By adhering to a policy of complete excision of all lesions, the recurrence rate should be 10% or less.

Patient Education

  • Patients need to be informed that recurrences are possible even years after excision, so they should have routine eye examinations.
  • The general public needs to be educated to have suspicious eye lesions, even chronic red eyes, evaluated promptly to rule out early ocular surface malignancies. Educating people who live in tropical areas and in regions with a high degree of solar exposure is particularly important.

Miscellaneous

Medicolegal Pitfalls

  • An elderly patient presents with a chronic unilateral bulbar conjunctival lesion that is excised via frozen-section control, and shown to be squamous cell carcinoma with episcleral involvement. His immediate postoperative course is uneventful. He informs the office staff that he will be moving out of the state 2 months after the operation. It is critical for the operating physician in this situation to provide the medical record and operative/pathology report to the patient and to encourage the patient to continue frequent follow-up with the new physician. The patient also should be assisted in locating a new physician to provide this care.
  • A 32-year-old male patient presents with a leukoplakic lesion, the biopsy of which reveals squamous cell carcinoma. It is important for the surgeon to investigate risk factors for HIV exposure in this patient and to encourage HIV testing and follow-up care with the appropriate specialist.

Special Concerns

  • Patients with an atypical pterygium may have a conjunctival tumor. These patients should be observed much more closely than patients with a classic pterygium.
 


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

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  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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