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Squamous Cell Carcinoma, Eyelid: Differential Diagnoses & Workup

Author: Michael T Yen, MD, Associate Professor of Ophthalmology, Department of Ophthalmology, Division of Ophthalmic Plastic, Lacrimal, and Orbital Surgery, Cullen Eye Institute, Baylor College of Medicine
Contributor Information and Disclosures

Updated: Feb 5, 2009

Differential Diagnoses

Basal Cell Carcinoma, Eyelid
Dermatitis, Contact
Blepharitis, Adult
Hordeolum
Chalazion
Squamous Cell Carcinoma, Conjunctival
Dermatitis, Atopic
Xanthelasma

Other Problems to Be Considered

Actinic keratosis
Eyelid malignant melanoma
Eyelid sebaceous cell carcinoma

Workup

Laboratory Studies

  • Liver function tests, if metastasis is suspected
  • Genetic analysis for xeroderma pigmentosum, if patient is young and there is no history of occupational exposure or excessive sun exposure
  • HIV test, if patient is young and there is no history of occupational exposure or excessive sun exposure, and xeroderma pigmentosum has been excluded

Imaging Studies

  • CT scan
    • To evaluate depth of extension into orbit and bony erosions
    • Liver scans or full body CT scan, if metastasis is suspected

Other Tests

  • Photography - To document appearance of lesion
External photograph of a large ulcerated invasive...

External photograph of a large ulcerated invasive squamous cell carcinoma of the left lower eyelid. This patient also had perineural invasion of the infraorbital nerve extending into the cranial base.

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External photograph of a large ulcerated invasive...

External photograph of a large ulcerated invasive squamous cell carcinoma of the left lower eyelid. This patient also had perineural invasion of the infraorbital nerve extending into the cranial base.


Procedures

  • Incisional biopsy for histological diagnosis

Histologic Findings

Squamous cell carcinoma may arise de novo or from premalignant lesions such as actinic keratosis or intraepidermal carcinoma (carcinoma in situ). Intraepidermal squamous cell carcinoma is characterized by full-thickness epidermal atypia (cellular atypia, loss of polarity, pleomorphic and/or hyperchromatic nuclei, mitotic figures, and parakeratosis).6

Invasive squamous cell carcinoma is present when cellular atypia penetrates through the epidermal basement membrane.

In well-differentiated squamous cell carcinoma, cells are polygonal with abundant cytoplasm. Dyskeratotic cells with keratin pearls are present. Nuclei are prominent, hyperchromatic, and pleomorphic. Mitotic figures are commonly present; loss of polarity of normal epidermal architecture can be seen. Poorly differentiated lesions may show little or no evidence of keratinization.6

More on Squamous Cell Carcinoma, Eyelid

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

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  2. Dailey JR, Kennedy RH, Flaharty PM, et al. Squamous cell carcinoma of the eyelid. Ophthal Plast Reconstr Surg. Sep 1994;10(3):153-9. [Medline].

  3. Thosani MK, Schneck G, Jones EC. Periocular squamous cell carcinoma. Dermatol Surg. May 2008;34(5):585-99. [Medline].

  4. Doxanas MT, Iliff WJ, Iliff NT, Green WR. Squamous cell carcinoma of the eyelids. Ophthalmology. May 1987;94(5):538-41. [Medline].

  5. Reifler DM, Hornblass A. Squamous cell carcinoma of the eyelid. Surv Ophthalmol. May-Jun 1986;30(6):349-65. [Medline].

  6. Kwitko ML, Boniuk M, Zimmerman LE. Eyelid tumors with reference to lesions confused with squamous cell carcinoma. I. Incidence and errors in diagnosis. Arch Ophthalmol. Jun 1963;69:693-7. [Medline].

  7. McCarty JH, Barry M, Crowley D, Bronson RT, Lacy-Hulbert A, Hynes RO. Genetic ablation of alphav integrins in epithelial cells of the eyelid skin and conjunctiva leads to squamous cell carcinoma. Am J Pathol. Jun 2008;172(6):1740-7. [Medline].

  8. Gilberg SM, Tse DT. Malignant eyelid tumors. Ophthalmol Clin. 5:261-85.

  9. Maclean H, Dhillon B, Ironside J. Squamous cell carcinoma of the eyelid and the acquired immunodeficiency syndrome. Am J Ophthalmol. Feb 1996;121(2):219-21. [Medline].

  10. Maurer TA, Christian KV, Kerschmann RL, et al. Cutaneous squamous cell carcinoma in human immunodeficiency virus- infected patients. A study of epidemiologic risk factors, human papillomavirus, and p53 expression. Arch Dermatol. May 1997;133(5):577-83. [Medline].

  11. Boyer JD, Sullivan TJ, Whitehead KJ, Kelly LE, Allison RW. The management of perineural spread of squamous cell carcinoma to the ocular adnexae. Ophthal Plast Reconstr Surg. 2003;19:275-281. [Medline].

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  15. Seite S, Colige A, Piquemal-Vivenot P. A full-UV spectrum absorbing daily use cream protects human skin against biological changes occurring in photoaging. Photodermatol Photoimmunol Photomed. Aug 2000;16(4):147-55. [Medline].

  16. Seite S, Moyal D, Richard S. Mexoryl SX: a broad absorption UVA filter protects human skin from the effects of repeated suberythemal doses of UVA. J Photochem Photobiol B. Jun 15 1998;44(1):69-76. [Medline].

  17. Mohs FE. Micrographic surgery for the microscopically controlled excision of eyelid cancers. Arch Ophthalmol. Jun 1986;104(6):901-9. [Medline].

  18. Rio E, Bardet E, Ferron C. Interstitial brachytherapy of periorificial skin carcinomas of the face: a retrospective study of 97 cases. Int J Radiat Oncol Biol Phys. Nov 1 2005;63(3):753-7. [Medline].

  19. Rossi R, Puccioni M, Mavilia L, Campolmi P, Mori M, Cappuccini A, et al. Squamous cell carcinoma of the eyelid treated with photodynamic therapy. J Chemother. 2004;16:306-309. [Medline].

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Further Reading

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Keywords

eyelid squamous cell carcinoma, eyelid skin cancer, eyelid malignancy, eyelid neoplasm, SCC, facial skin cancer, skin carcinoma, adenoacanthoma, adenoid squamous cell carcinoma, invasive squamous cell carcinoma, malignant squamous cell carcinoma, pseudoglandular squamous cell carcinoma, actinic keratosis, xeroderma pigmentosum, eyelid radiation therapy

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Contributor Information and Disclosures

Author

Michael T Yen, MD, Associate Professor of Ophthalmology, Department of Ophthalmology, Division of Ophthalmic Plastic, Lacrimal, and Orbital Surgery, Cullen Eye Institute, Baylor College of Medicine
Michael T Yen, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, American Society of Ophthalmic Plastic and Reconstructive Surgery, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Ron W Pelton, MD, PhD, Private Practice, Colorado Springs, Colorado
Ron W Pelton, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Colorado Medical Society, Utah Medical Association, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Mark T Duffy, MD, PhD, Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic
Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience
Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting; Quest medical - lacrimal balloons Honoraria Speaking and teaching; Ortho-Neutrogenia Consulting fee Consulting

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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