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January 1997, Vol 115, No. 1 >
ARTICLE | January 1997

Secondary Squamous Cell Carcinoma of the Orbit FREE

Thomas E. Johnson, MD; Khalid F. Tabbara, MD; Robert G. Weatherhead, FRACS; Robert C. Kersten, MD; Charles Rice, MD; Amin M. Nasr, MD
Arch Ophthalmol. 1997;115(1):75-78. doi:10.1001/archopht.1997.01100150077013
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Objective:  To evaluate the origin and biological behavior of secondary orbital squamous cell (SCC) and mucoepidermoid carcinoma.

Methods:  A retrospective review of 30 consecutive patients with SCC and mucoepidermoid carcinoma of the orbit seen over a period of 8 years at a large ophthalmic hospital in Saudi Arabia.

Results:  A total of 51 secondary orbital tumors were seen in the 8-year period from 1983 through 1991; 30 (60%) of the 51 cases were SCC. There were 16 male and 14 female patients, with an age range of 38 to 80 years and a mean age of 65 years. In 28 (93%) of the 30 patients, the tumor originated in the conjunctiva. Orbital involvement by conjunctival SCC was the most common cause of secondary orbital tumors encountered in patients older than 19 years. Four patients had concomitant paranasal sinus involvement, 4 patients exhibited intraocular invasion, and 2 others were found to have intracranial extension of the SCC. Six (20%) of the 28 patients developed regional lymph node metastases during the course of their illness. All patients were treated by orbital exenteration, with or without radiation therapy. Seven (23%) of the 28 patients died of their disease.

Conclusions:  Orbital SCC is an aggressive and lifethreatening condition. Most cases result from secondary extension of conjunctival SCC, a common disease in Saudi Arabia. Several factors contribute to the aggressiveness of conjunctival SCC in this geographic location, including continual exposure to UV rays, chronic irritation, and genetic factors. Delay in presentation for treatment, inadequate initial resection of conjunctival lesions, and the aggressive mucoepidermoid carcinoma variant of SCC are also factors contributing to orbital invasion.

REFERENCES

1 +
Henderson JW. Orbital Tumors . 3rd ed. New York, NY: Raven Press: 1994;:343-360.
2 +
Rootman J, Robertson WD.  Tumors . In: Rootman J, ed. Diseases of the Orbit . Philadelphia, Pa: JB Lippincott Co; 1988;:121-123, 427, 440-441.
3 +
Tabbara KF, Kersten R, Daouk N, Blodi FC.  Metastatic squamous cell carcinoma of the conjunctiva . Ophthalmology . 1988;;95:318-321.
4 +
Zimmerman LE.  Squamous cell carcinoma and related lesions of the bulbar conjunctiva . In: Boniuk M, ed. Ocular and Adnexal Tumors: New and Controversial Aspects . St Louis, Mo: CV Mosby Co; 1964;:49-74.
5 +
Zimmerman LE.  The cancerous, precancerous and pseudocancerous lesions of the cornea and conjunctiva . In: Rycroft PV, ed. Corneoplastic Surgery: Proceedings of the Second International Corneoplastic Conference . New York, NY: Pergamon Press; 1969;:547-555.
6 +
Pizzarello LD, Jacobiec FA.  Bowen's disease of the conjunctiva: a misnomer . In: Jacobiec FA, ed. Ocular and Adnexal Tumors . Birmingham, Ala: Aesculapius Publishing Co; 1978;:553-571.
7 +
Iliff WJ, Marback R, Green WR.  Invasive squamous cell carcinoma of the conjunctiva . Arch Ophthalmol . 1975;;93:119-122.
8 +
Malik MO, El Sheikh EH.  Tumors of the eye and adnexa in the Sudan . Cancer . 1979;;44:293-303.
9 +
Clear AS, Chirambo MC, Hutt MS.  Solar keratosis, pterygium, and squamous cell carcinoma of the conjunctiva in Malawi . Br J Ophthalmol . 1979;;63:102-109.
10 +
Blodi FC.  Squamous cell carcinoma of the conjunctiva . Doc Ophthalmol . 1973;;34:93-108.
11 +
Shields JA. Bakewell B, Augsburger JJ, Flanagan JC.  Classification and incidence of space-occupying lesions of the orbit: a survey of 645 biopsies . Arch Ophthalmol . 1984;;102:1606-1611.
12 +
Bullock JD, Augsburger J.  Squamous cell carcinoma of the orbit . Ann Ophthalmol . 1980;;2:255-258.
13 +
Grutzmacher RD, Fraunfelder FT.  Corneal and bulbar conjunctival tumors . In: Abbott RL, ed. Surgical Intervention in Corneal and External Diseases . Orlando, Fla: Grune & Stratton; 1987;:119-139.
14 +
McDonnell JM, McDonnell PJ, Mounts P, Wu T-C, Green WR.  Demonstration of papillomavirus capsid antigen in human conjunctival neoplasia . Arch Ophthalmol . 1986;;104:1801-1805.
15 +
Donn WL. Climate and Ice Ages: Meteorology . 4th ed. New York, NY: McGraw-Hill Book Co; 1975;:429.
16 +
Cooper JS, Pajak TF, Rubin PR. et al.  Second malignancies in patients who have head and neck cancer: incidence, effect on survival and implications based on the RTOG experience . Int J Radiation Oncology Biol Phys . 1989;;17:449-456.
17 +
de Vries N, Drexhage HA, de Waal LP, de Lange G, Snow GB.  Human leukocyte antigens and immunoglobulin allotypes in head and neck cancer patients with and without multiple primary tumors . Cancer . 1987;;60:957-961.
18 +
Nicholson DH, Herschler J.  Intraocular extension of squamous cell carcinoma of the conjunctiva . Arch Ophthalmol . 1977;;95:843-846.
19 +
Thackray AC, Lucas RB.  Tumors of the major salivary glands . Atlas of Tumor Pathology . Washington, DC: Armed Forces Institute of Pathology; 1974;;2:69-80.
20 +
Brownstein S.  Mucoepidermoid carcinoma of the conjunctiva with intraocular invasion . Ophthalmology . 1981;;88:1226-1230.
21 +
Rao NA, Font RL.  Mucoepidermoid carcinoma of the conjunctiva . Cancer . 1976;;38:1699-1709.
22 +
Searl SS, Krigstein HJ, Albert DM, Grove AS.  Invasive squamous cell carcinoma with intraocular mucoepidermoid features: conjunctival carcinoma with intraocular invasion and diphasic morphology . Arch Ophthalmol . 1982;;100:109-111.
23 +
Gamel JW, Eiferman RA, Guibor P.  Mucoepidermoid carcinoma of the conjunctiva . Arch Ophthalmol . 1984;;102:730-731.
24 +
Shields JA.  Secondary orbital tumors . In: Shields JA, ed. Diagnosis and Management of Orbital Tumors . Philadelphia, Pa: WB Saunders Co; 1989;:350-352.
25 +
Fraunfelder FT, Wingfield D.  Management of intraepithelial conjunctival tumors and squamous cell carcinoma . Am J Ophthalmol . 1983;;95:359-363.
26 +
Buus DR. Tse DT, Folberg R.  Microscopically controlled excision of conjunctival squamous cell carcinoma . Am J Ophthalmol . 1994;;117:97-102.
27 +
Reese AB.  Epithelial tumors of the lid, conjunctiva, corneal and lacrimal sac . In: Reese AB, ed. Tumors of the Eye . 3rd ed. Hagerstown, Md: Harper & Row; 1976;:55.

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1 +
Henderson JW. Orbital Tumors . 3rd ed. New York, NY: Raven Press: 1994;:343-360.
2 +
Rootman J, Robertson WD.  Tumors . In: Rootman J, ed. Diseases of the Orbit . Philadelphia, Pa: JB Lippincott Co; 1988;:121-123, 427, 440-441.
3 +
Tabbara KF, Kersten R, Daouk N, Blodi FC.  Metastatic squamous cell carcinoma of the conjunctiva . Ophthalmology . 1988;;95:318-321.
4 +
Zimmerman LE.  Squamous cell carcinoma and related lesions of the bulbar conjunctiva . In: Boniuk M, ed. Ocular and Adnexal Tumors: New and Controversial Aspects . St Louis, Mo: CV Mosby Co; 1964;:49-74.
5 +
Zimmerman LE.  The cancerous, precancerous and pseudocancerous lesions of the cornea and conjunctiva . In: Rycroft PV, ed. Corneoplastic Surgery: Proceedings of the Second International Corneoplastic Conference . New York, NY: Pergamon Press; 1969;:547-555.
6 +
Pizzarello LD, Jacobiec FA.  Bowen's disease of the conjunctiva: a misnomer . In: Jacobiec FA, ed. Ocular and Adnexal Tumors . Birmingham, Ala: Aesculapius Publishing Co; 1978;:553-571.
7 +
Iliff WJ, Marback R, Green WR.  Invasive squamous cell carcinoma of the conjunctiva . Arch Ophthalmol . 1975;;93:119-122.
8 +
Malik MO, El Sheikh EH.  Tumors of the eye and adnexa in the Sudan . Cancer . 1979;;44:293-303.
9 +
Clear AS, Chirambo MC, Hutt MS.  Solar keratosis, pterygium, and squamous cell carcinoma of the conjunctiva in Malawi . Br J Ophthalmol . 1979;;63:102-109.
10 +
Blodi FC.  Squamous cell carcinoma of the conjunctiva . Doc Ophthalmol . 1973;;34:93-108.
11 +
Shields JA. Bakewell B, Augsburger JJ, Flanagan JC.  Classification and incidence of space-occupying lesions of the orbit: a survey of 645 biopsies . Arch Ophthalmol . 1984;;102:1606-1611.
12 +
Bullock JD, Augsburger J.  Squamous cell carcinoma of the orbit . Ann Ophthalmol . 1980;;2:255-258.
13 +
Grutzmacher RD, Fraunfelder FT.  Corneal and bulbar conjunctival tumors . In: Abbott RL, ed. Surgical Intervention in Corneal and External Diseases . Orlando, Fla: Grune & Stratton; 1987;:119-139.
14 +
McDonnell JM, McDonnell PJ, Mounts P, Wu T-C, Green WR.  Demonstration of papillomavirus capsid antigen in human conjunctival neoplasia . Arch Ophthalmol . 1986;;104:1801-1805.
15 +
Donn WL. Climate and Ice Ages: Meteorology . 4th ed. New York, NY: McGraw-Hill Book Co; 1975;:429.
16 +
Cooper JS, Pajak TF, Rubin PR. et al.  Second malignancies in patients who have head and neck cancer: incidence, effect on survival and implications based on the RTOG experience . Int J Radiation Oncology Biol Phys . 1989;;17:449-456.
17 +
de Vries N, Drexhage HA, de Waal LP, de Lange G, Snow GB.  Human leukocyte antigens and immunoglobulin allotypes in head and neck cancer patients with and without multiple primary tumors . Cancer . 1987;;60:957-961.
18 +
Nicholson DH, Herschler J.  Intraocular extension of squamous cell carcinoma of the conjunctiva . Arch Ophthalmol . 1977;;95:843-846.
19 +
Thackray AC, Lucas RB.  Tumors of the major salivary glands . Atlas of Tumor Pathology . Washington, DC: Armed Forces Institute of Pathology; 1974;;2:69-80.
20 +
Brownstein S.  Mucoepidermoid carcinoma of the conjunctiva with intraocular invasion . Ophthalmology . 1981;;88:1226-1230.
21 +
Rao NA, Font RL.  Mucoepidermoid carcinoma of the conjunctiva . Cancer . 1976;;38:1699-1709.
22 +
Searl SS, Krigstein HJ, Albert DM, Grove AS.  Invasive squamous cell carcinoma with intraocular mucoepidermoid features: conjunctival carcinoma with intraocular invasion and diphasic morphology . Arch Ophthalmol . 1982;;100:109-111.
23 +
Gamel JW, Eiferman RA, Guibor P.  Mucoepidermoid carcinoma of the conjunctiva . Arch Ophthalmol . 1984;;102:730-731.
24 +
Shields JA.  Secondary orbital tumors . In: Shields JA, ed. Diagnosis and Management of Orbital Tumors . Philadelphia, Pa: WB Saunders Co; 1989;:350-352.
25 +
Fraunfelder FT, Wingfield D.  Management of intraepithelial conjunctival tumors and squamous cell carcinoma . Am J Ophthalmol . 1983;;95:359-363.
26 +
Buus DR. Tse DT, Folberg R.  Microscopically controlled excision of conjunctival squamous cell carcinoma . Am J Ophthalmol . 1994;;117:97-102.
27 +
Reese AB.  Epithelial tumors of the lid, conjunctiva, corneal and lacrimal sac . In: Reese AB, ed. Tumors of the Eye . 3rd ed. Hagerstown, Md: Harper & Row; 1976;:55.

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