Eye
Conjunctiva
Squamous cell carcinoma


Topic Completed: 1 September 2013

Revised: 28 March 2019

Copyright: 2004-2019, PathologyOutlines.com, Inc.

PubMed Search: Squamous cell carcinoma conjunctiva [title]

Nat Pernick, M.D.
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Cite this page: Pernick N. Conjunctiva: squamous cell carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/eyeconjSCC.html. Accessed July 24th, 2019.
Definition / general
  • See also spindle cell carcinoma, mucoepidermoid carcinoma
  • Rare but more common than basal cell carcinoma at this site
  • In US, precancerous lesions are excised, so invasive carcinoma is uncommon
  • Rates: 0.03 per 100K in US, 3.5 per 100K in Uganda
  • Mainly adults
  • In US commonly 60+ years, 55 - 70% men (Can J Ophthalmol 2002;37:14)
  • Associated with sunlight exposure, actinic keratosis; also xeroderma pigmentosum, albinism, toxins, HPV 16/18 (55%), possibly atopic eczema (Cornea 2003;22:135)
  • May invade anterior chamber of globe or orbit but only rarely metastasizes or causes death
Clinical features
  • HIV / AIDS patients
    • Rising incidence with 8% prevalence in Kenya (East Afr Med J 2006;83:267)
    • Recommended to screen HIV / AIDS patients for conjunctival lesions
    • Mean age is 35 years
    • Usually affects women
    • Patients present late with advanced disease
    • More aggressive with high recurrence rates
Case reports
Treatment
  • Complete excision of superficial tumors
  • Radical surgery for deeply invasive tumors
  • 6% recur
  • Rarely metastasize to lymph nodes (more common if large or multiple recurrences)
Clinical images

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Nodular tumor with prominent vascularity at limbus

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Fleshy elevated lesion at limbus

Gross description
  • Papillary or exophytic gray-white mass, often at limbus
  • Occasionally jet black resembling melanoma (in heavily pigmented individuals)
  • Surrounded by inflamed conjunctiva
Gross images

AFIP images
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Large limbal tumor invades anterior chamber

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Tumor has destroyed eye and invaded orbit

Microscopic (histologic) description
  • Atypia throughout full thickness of epithelium (conjunctival intraepithelial neoplasia) with individual tumor cells or nests extending into underlying stroma
  • Dense sclera usually limits deepest margins
  • Epithelium may be keratinized
  • Cells have eosinophilic or clear cytoplasm, intercellular bridges, dyskeratosis, coarse chromatin, prominent nucleoli
  • May have pigment within benign and malignant cells in heavily pigmented patients (Ophthalmic Surg Lasers Imaging 2003;34:406)
Microscopic (histologic) images

AFIP images
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Early invasion with corneal involvement

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Well differentiated tumor with deep invasion

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Metastasis to preauricular node and parotid gland



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Thick layer of parakeratosis and microinvasion

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Lobules of invasive keratinizing carcinoma in stroma

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Papillomatous pattern

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Squamoid nests

Positive stains
Molecular / cytogenetics description
  • Usually aneuploid
Additional references
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