eMedicine Specialties > Ophthalmology > Conjunctiva

Squamous Cell Carcinoma, Conjunctival

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

Introduction

Background

Squamous cell carcinoma of the conjunctiva is a malignant epithelial neoplasm characterized by basement membrane invasion or distant metastasis. Epithelial tumors of the conjunctiva are similar to conjunctival intraepithelial neoplasia (CIN).

Squamous cell carcinoma of the conjunctiva represents a form of CIN that has either broken through the basement membrane to involve the subepithelial tissue or has metastasized. Morbidity is related primarily to local involvement of the conjunctiva and cornea, although regional spread and distant metastasis are possible. Rarely ocular penetration can occur, particularly with the mucoepidermoid type.

Pathophysiology

Squamous cell carcinoma is believed to arise from limbal stem cells and presents as a mass in the interpalpebral fissure at the nasal or temporal limbus. It may have a gelatinous and velvety, papilliform, or leukoplakic appearance. Given its variable appearance, it may pose a diagnostic challenge as a masquerade syndrome.

Frequency

United States

Squamous cell carcinoma is the most common conjunctival malignancy in the United States.

International

Patients who live close to the equator tend to present at a younger age than patients who live more distant from the equator. The incidence of the disease varies geographically, 0.03-3.5 cases per 100,000 people per year.

Mortality/Morbidity

The morbidity from squamous cell carcinoma of the conjunctiva relates to the ocular side effects of the disease and its treatment, as well as regional orbital sequelae, periorbital spread, periorbital sinus involvement, and intracranial involvement. Death may result from distant or regional metastases, as well as intracranial spread.

Race

Squamous cell carcinoma of the conjunctiva is most common in Caucasian individuals.

Sex

Squamous cell carcinoma is more common in males (75%) than in females (25%).

Age

Patients with squamous cell carcinoma of the conjunctiva tend to be elderly, with an average age of 60 years. Patients with acquired immunodeficiency syndrome (AIDS) have a 13-fold increased risk of developing conjunctival epithelial malignancies; these patients also present at a younger age.

Clinical

History

  • Various factors have been shown to be associated with squamous cell carcinoma of the conjunctiva, including human papilloma virus (HPV) infection, cigarette smoking, petroleum products, light hair, European ancestry, actinic exposure, AIDS, and chronic wear of contact lenses.
  • Individuals who are HIV positive and patients with xeroderma pigmentosa also are more likely to develop squamous cell carcinoma of the conjunctiva probably because of their diminished immune status.
  • Patients may notice a conjunctival mass, which may be enlarging. Often, small conjunctival masses are noted on routine eye examinations.
  • Irritation and/or chronic conjunctivitis may also be presenting signs.

Physical

Distinguishing squamous cell carcinoma from CIN is difficult on clinical examination alone.

  • Most squamous cell carcinomas involving the conjunctiva manifest as chronic unilateral localized patches of redness or more diffuse conjunctivitis.
  • The corneoscleral limbus is the most common location, although the palpebral conjunctiva or cornea may be involved, particularly in the interpalpebral region.
  • Usually, the lesions have a gelatinous appearance with a papillomatous vessel pattern, often with overlying keratin deposition (leukoplakia), and prominent feeder vessels.
  • Examination should determine the full extent of the lesion.
  • Rose bengal dye is helpful for determining the exact extent of the lesion.
  • Assess any suspicion for intraocular involvement via slit lamp examination, gonioscopy, and echography.
  • Orbital involvement should be investigated with CT scan or MRI.
  • Investigate regional spread by palpating for enlarged lymph nodes in the head and neck region.

Causes

  • Purported causes of squamous cell carcinoma of the conjunctiva include the following:
    • Excessive ultraviolet light
    • HPV types 16 and 18
    • Long-standing inflammation
    • Cigarette smoking
    • Petroleum products
    • Light hair
    • European ancestry
    • Chronic wear of contact lenses
    • Immunodeficiency syndrome

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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