Skip to main content
PMC home page
The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 1999 Jan;83(1):98–103. doi: 10.1136/bjo.83.1.98

Intraepithelial and invasive squamous cell carcinoma of the conjunctiva: analysis of 60 cases

M Tunc 1, D Char 1, B Crawford 1, T Miller 1
PMCID: PMC1722787  PMID: 10209445

Abstract

AIM—To evaluate the clinical features, treatment results, and recurrence rates in patients with either intraepithelial or invasive squamous cell carcinoma of the conjunctiva.
METHODS—Retrospective analysis of 60 cases (22 conjunctival intraepithelial and 38 invasive squamous cell carcinomas) to determine patterns of clinical presentation, aetiological factors, and treatment results. The mean patient age was 64 years old. 70% of the patients were male. Patients were treated with a variety of therapies, depending on the degree of tumour involvement; most cases were treated with frozen section controlled excision and adjunctive cryotherapy. Modified eye wall resection or enucleation was done for intraocular invasion and exenteration was done for orbital involvement.
RESULTS—Red eye (68%) and ocular irritation (57%) were the most common presenting symptoms. 44% of the patients had other eye findings consistent with extensive solar exposure. 20% of the patients had a history of malignant skin tumours. Visceral malignancies developed in 8%. Scleral involvement was present in 14 (37%), intraocular involvement in five (13%), and orbital invasion in four (11%) cases with invasive squamous cell carcinoma. After a mean follow up of 56 months (18-226 months) the rate of new or recurrent tumours was 4.5% for intraepithelial squamous carcinoma and 5.3% for invasive squamous cell carcinoma. No patient developed metastases or tumour related deaths.
CONCLUSION—Excision with intraoperative control of the surgical margins and adjunctive cryotherapy results in good tumour control rates.

 Keywords: squamous cell carcinoma; conjunctiva

Full Text

The Full Text of this article is available as a PDF (96.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brash D. E., Rudolph J. A., Simon J. A., Lin A., McKenna G. J., Baden H. P., Halperin A. J., Pontén J. A role for sunlight in skin cancer: UV-induced p53 mutations in squamous cell carcinoma. Proc Natl Acad Sci U S A. 1991 Nov 15;88(22):10124–10128. doi: 10.1073/pnas.88.22.10124. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Burk R. D., Kadish A. S. Treasure hunt for human papillomaviruses in nonmelanoma skin cancers. J Natl Cancer Inst. 1996 Jun 19;88(12):781–782. doi: 10.1093/jnci/88.12.781. [DOI] [PubMed] [Google Scholar]
  3. Buus D. R., Tse D. T., Folberg R., Buuns D. R. Microscopically controlled excision of conjunctival squamous cell carcinoma. Am J Ophthalmol. 1994 Jan 15;117(1):97–102. doi: 10.1016/s0002-9394(14)73021-1. [DOI] [PubMed] [Google Scholar]
  4. Cha S. B., Shields C. L., Shields J. A., Eagel R. C., Jr, De Potter P., Talansky M. Massive precorneal extension of squamous cell carcinoma of the conjunctiva. Cornea. 1993 Nov;12(6):537–540. doi: 10.1097/00003226-199311000-00013. [DOI] [PubMed] [Google Scholar]
  5. Cha S. B., Shields J. A., Shields C. L., Wang M. X. Squamous cell carcinoma of the conjunctiva. Int Ophthalmol Clin. 1993 Summer;33(3):19–24. doi: 10.1097/00004397-199303330-00005. [DOI] [PubMed] [Google Scholar]
  6. Char D. H., Crawford J. B., Howes E. L., Jr, Weinstein A. J. Resection of intraocular squamous cell carcinoma. Br J Ophthalmol. 1992 Feb;76(2):123–125. doi: 10.1136/bjo.76.2.123. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Chute C. G., Chuang T. Y., Bergstralh E. J., Su W. P. The subsequent risk of internal cancer with Bowen's disease. A population-based study. JAMA. 1991 Aug 14;266(6):816–819. [PubMed] [Google Scholar]
  8. Copeland R. A., Jr, Char D. H. Limbal autograft reconstruction after conjunctival squamous cell carcinoma. Am J Ophthalmol. 1990 Oct 15;110(4):412–415. doi: 10.1016/s0002-9394(14)77023-0. [DOI] [PubMed] [Google Scholar]
  9. Coster D. J., Aggarwal R. K., Williams K. A. Surgical management of ocular surface disorders using conjunctival and stem cell allografts. Br J Ophthalmol. 1995 Nov;79(11):977–982. doi: 10.1136/bjo.79.11.977. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Erie J. C., Campbell R. J., Liesegang T. J. Conjunctival and corneal intraepithelial and invasive neoplasia. Ophthalmology. 1986 Feb;93(2):176–183. doi: 10.1016/s0161-6420(86)33764-3. [DOI] [PubMed] [Google Scholar]
  11. Fraunfelder F. T., Wingfield D. Management of intraepithelial conjunctival tumors and squamous cell carcinomas. Am J Ophthalmol. 1983 Mar;95(3):359–363. doi: 10.1016/s0002-9394(14)78306-0. [DOI] [PubMed] [Google Scholar]
  12. Frucht-Pery J., Sugar J., Baum J., Sutphin J. E., Pe'er J., Savir H., Holland E. J., Meisler D. M., Foster J. A., Folberg R. Mitomycin C treatment for conjunctival-corneal intraepithelial neoplasia: a multicenter experience. Ophthalmology. 1997 Dec;104(12):2085–2093. doi: 10.1016/s0161-6420(97)30055-4. [DOI] [PubMed] [Google Scholar]
  13. Glasson W. J., Hirst L. W., Axelsen R. A., Moon M. Invasive squamous cell carcinoma of the conjunctiva. Arch Ophthalmol. 1994 Oct;112(10):1342–1345. doi: 10.1001/archopht.1994.01090220092029. [DOI] [PubMed] [Google Scholar]
  14. Goldberg S. H., Riedy D. K., Lanzillo J. H. Invasive squamous cell carcinoma of the palpebral conjunctiva. Graefes Arch Clin Exp Ophthalmol. 1993 Apr;231(4):246–248. doi: 10.1007/BF00918850. [DOI] [PubMed] [Google Scholar]
  15. Grossniklaus H. E., Green W. R., Luckenbach M., Chan C. C. Conjunctival lesions in adults. A clinical and histopathologic review. Cornea. 1987;6(2):78–116. doi: 10.1097/00003226-198706020-00002. [DOI] [PubMed] [Google Scholar]
  16. Heffler K. F. Tumors of the cornea and conjunctiva. Curr Opin Ophthalmol. 1995 Aug;6(4):32–38. doi: 10.1097/00055735-199508000-00007. [DOI] [PubMed] [Google Scholar]
  17. Heigle T. J., Stulting R. D., Palay D. A. Treatment of recurrent conjunctival epithelial neoplasia with topical mitomycin C. Am J Ophthalmol. 1997 Sep;124(3):397–399. doi: 10.1016/s0002-9394(14)70834-7. [DOI] [PubMed] [Google Scholar]
  18. Hertle R. W., Durso F., Metzler J. P., Varsa E. W. Epibulbar squamous cell carcinomas in brothers with Xeroderma pigmentosa. J Pediatr Ophthalmol Strabismus. 1991 Nov-Dec;28(6):350–353. doi: 10.3928/0191-3913-19911101-15. [DOI] [PubMed] [Google Scholar]
  19. Holly E. A., Aston D. A., Ahn D. K., Kristiansen J. J., Char D. H. No excess prior cancer in patients with uveal melanoma. Ophthalmology. 1991 May;98(5):608–611. doi: 10.1016/s0161-6420(91)32244-9. [DOI] [PubMed] [Google Scholar]
  20. Iliff W. J., Marback R., Green W. R. Invasive squamous cell carcinoma of the conjunctiva. Arch Ophthalmol. 1975 Feb;93(2):119–122. doi: 10.1001/archopht.1975.01010020125005. [DOI] [PubMed] [Google Scholar]
  21. Irvine A. R. Dyskeratotic Epibulbar Tumors. Trans Am Ophthalmol Soc. 1963;61:243–273. [PMC free article] [PubMed] [Google Scholar]
  22. Johnson T. E., Tabbara K. F., Weatherhead R. G., Kersten R. C., Rice C., Nasr A. M. Secondary squamous cell carcinoma of the orbit. Arch Ophthalmol. 1997 Jan;115(1):75–78. doi: 10.1001/archopht.1997.01100150077013. [DOI] [PubMed] [Google Scholar]
  23. Karagas M. R., Stukel T. A., Greenberg E. R., Baron J. A., Mott L. A., Stern R. S. Risk of subsequent basal cell carcinoma and squamous cell carcinoma of the skin among patients with prior skin cancer. Skin Cancer Prevention Study Group. JAMA. 1992 Jun 24;267(24):3305–3310. [PubMed] [Google Scholar]
  24. Karcioglu Z. A., Issa T. M. Human papilloma virus in neoplastic and non-neoplastic conditions of the external eye. Br J Ophthalmol. 1997 Jul;81(7):595–598. doi: 10.1136/bjo.81.7.595. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Karp C. L., Scott I. U., Chang T. S., Pflugfelder S. C. Conjunctival intraepithelial neoplasia. A possible marker for human immunodeficiency virus infection? Arch Ophthalmol. 1996 Mar;114(3):257–261. doi: 10.1001/archopht.1996.01100130253003. [DOI] [PubMed] [Google Scholar]
  26. Kearsley J. H., Fitchew R. S., Taylor R. G. Adjunctive radiotherapy with strontium-90 in the treatment of conjunctival squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 1988 Mar;14(3):435–443. doi: 10.1016/0360-3016(88)90257-x. [DOI] [PubMed] [Google Scholar]
  27. Khalil M. K., Pierson R. B., Mihalovits H., Bell R. A., Lorenzetti D. W. Intraepithelial neoplasia of the bulbar conjunctiva clinically presenting as diffuse papillomatosis. Can J Ophthalmol. 1993 Oct;28(6):287–290. [PubMed] [Google Scholar]
  28. Kripke M. L. Ultraviolet radiation and immunology: something new under the sun--presidential address. Cancer Res. 1994 Dec 1;54(23):6102–6105. [PubMed] [Google Scholar]
  29. Lauer S. A., Malter J. S., Meier J. R. Human papillomavirus type 18 in conjunctival intraepithelial neoplasia. Am J Ophthalmol. 1990 Jul 15;110(1):23–27. doi: 10.1016/s0002-9394(14)76932-6. [DOI] [PubMed] [Google Scholar]
  30. Lee G. A., Hirst L. W. Incidence of ocular surface epithelial dysplasia in metropolitan Brisbane. A 10-year survey. Arch Ophthalmol. 1992 Apr;110(4):525–527. doi: 10.1001/archopht.1992.01080160103042. [DOI] [PubMed] [Google Scholar]
  31. Lee G. A., Hirst L. W. Ocular surface squamous neoplasia. Surv Ophthalmol. 1995 May-Jun;39(6):429–450. doi: 10.1016/s0039-6257(05)80054-2. [DOI] [PubMed] [Google Scholar]
  32. Lee G. A., Williams G., Hirst L. W., Green A. C. Risk factors in the development of ocular surface epithelial dysplasia. Ophthalmology. 1994 Feb;101(2):360–364. doi: 10.1016/s0161-6420(94)31328-5. [DOI] [PubMed] [Google Scholar]
  33. Lewallen S., Shroyer K. R., Keyser R. B., Liomba G. Aggressive conjunctival squamous cell carcinoma in three young Africans. Arch Ophthalmol. 1996 Feb;114(2):215–218. doi: 10.1001/archopht.1996.01100130209021. [DOI] [PubMed] [Google Scholar]
  34. Margo C. E., Mack W., Guffey J. M. Squamous cell carcinoma of the conjunctiva and human immunodeficiency virus infection. Arch Ophthalmol. 1996 Mar;114(3):349–349. doi: 10.1001/archopht.1996.01100130345024. [DOI] [PubMed] [Google Scholar]
  35. Mauriello J. A., Jr, Napolitano J., McLean I. Actinic keratosis and dysplasia of the conjunctiva: a clinicopathological study of 45 cases. Can J Ophthalmol. 1995 Oct;30(6):312–316. [PubMed] [Google Scholar]
  36. McDonnell J. M., McDonnell P. J., Sun Y. Y. Human papillomavirus DNA in tissues and ocular surface swabs of patients with conjunctival epithelial neoplasia. Invest Ophthalmol Vis Sci. 1992 Jan;33(1):184–189. [PubMed] [Google Scholar]
  37. Midena E., Boccato P., Angeli C. D. Conjunctival squamous cell carcinoma treated with topical 5-fluorouracil. Arch Ophthalmol. 1997 Dec;115(12):1600–1601. doi: 10.1001/archopht.1997.01100160770023. [DOI] [PubMed] [Google Scholar]
  38. Newton R. A review of the aetiology of squamous cell carcinoma of the conjunctiva. Br J Cancer. 1996 Nov;74(10):1511–1513. doi: 10.1038/bjc.1996.581. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Newton R., Ferlay J., Reeves G., Beral V., Parkin D. M. Effect of ambient solar ultraviolet radiation on incidence of squamous-cell carcinoma of the eye. Lancet. 1996 May 25;347(9013):1450–1451. doi: 10.1016/s0140-6736(96)91685-2. [DOI] [PubMed] [Google Scholar]
  40. Ni C., Searl S. S., Kriegstein H. J., Wu B. F. Epibulbar carcinoma. Int Ophthalmol Clin. 1982 Fall;22(3):1–33. doi: 10.1097/00004397-198202230-00005. [DOI] [PubMed] [Google Scholar]
  41. Odrich M. G., Jakobiec F. A., Lancaster W. D., Kenyon K. R., Kelly L. D., Kornmehl E. W., Steinert R. F., Grove A. S., Jr, Shore J. W., Gregoire L. A spectrum of bilateral squamous conjunctival tumors associated with human papillomavirus type 16. Ophthalmology. 1991 May;98(5):628–635. doi: 10.1016/s0161-6420(91)32218-8. [DOI] [PubMed] [Google Scholar]
  42. Peksayar G., Soytürk M. K., Demiryont M. Long-term results of cryotherapy on malignant epithelial tumors of the conjunctiva. Am J Ophthalmol. 1989 Apr 15;107(4):337–340. doi: 10.1016/0002-9394(89)90655-7. [DOI] [PubMed] [Google Scholar]
  43. Saegusa M., Takano Y., Hashimura M., Okayasu I., Shiga J. HPV type 16 in conjunctival and junctional papilloma, dysplasia, and squamous cell carcinoma. J Clin Pathol. 1995 Dec;48(12):1106–1110. doi: 10.1136/jcp.48.12.1106. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Schubert H. D., Farris R. L., Green W. R. Spindle cell carcinoma of the conjunctiva. Graefes Arch Clin Exp Ophthalmol. 1995 Jan;233(1):52–53. doi: 10.1007/BF00177787. [DOI] [PubMed] [Google Scholar]
  45. Seitz B., Fischer M., Holbach L. M., Naumann G. O. Differentialdiagnose und Prognose bei 112 exzidierten epibulbären epithelialen Tumoren. Klin Monbl Augenheilkd. 1995 Oct;207(4):239–246. doi: 10.1055/s-2008-1035375. [DOI] [PubMed] [Google Scholar]
  46. Seregard S., Kock E. Squamous spindle cell carcinoma of the conjunctiva. Fatal outcome of a plerygium-like lesion. Acta Ophthalmol Scand. 1995 Oct;73(5):464–466. doi: 10.1111/j.1600-0420.1995.tb00311.x. [DOI] [PubMed] [Google Scholar]
  47. Tabbara K. F., Kersten R., Daouk N., Blodi F. C. Metastatic squamous cell carcinoma of the conjunctiva. Ophthalmology. 1988 Mar;95(3):318–321. doi: 10.1016/s0161-6420(88)33180-5. [DOI] [PubMed] [Google Scholar]
  48. Tabin G., Levin S., Snibson G., Loughnan M., Taylor H. Late recurrences and the necessity for long-term follow-up in corneal and conjunctival intraepithelial neoplasia. Ophthalmology. 1997 Mar;104(3):485–492. doi: 10.1016/s0161-6420(97)30287-5. [DOI] [PubMed] [Google Scholar]
  49. Tuppurainen K., Raninen A., Kosunen O., Kankkunen J. P., Kellokoski J., Syrjänen S., Mäntyjärvi M., Syrjänen K. Squamous cell carcinoma of the conjunctiva. Failure to demonstrate HPV DNA by in situ hybridization and polymerase chain reaction. Acta Ophthalmol (Copenh) 1992 Apr;70(2):248–254. doi: 10.1111/j.1755-3768.1992.tb04132.x. [DOI] [PubMed] [Google Scholar]
  50. Wexler S. A., Wallow I. H. Squamous cell carcinoma of the conjunctiva presenting with intraocular extension. Arch Ophthalmol. 1985 Aug;103(8):1175–1177. doi: 10.1001/archopht.1985.01050080087027. [DOI] [PubMed] [Google Scholar]
  51. Wilson M. W., Hungerford J. L., George S. M., Madreperla S. A. Topical mitomycin C for the treatment of conjunctival and corneal epithelial dysplasia and neoplasia. Am J Ophthalmol. 1997 Sep;124(3):303–311. doi: 10.1016/s0002-9394(14)70822-0. [DOI] [PubMed] [Google Scholar]
  52. Yeatts R. P., Ford J. G., Stanton C. A., Reed J. W. Topical 5-fluorouracil in treating epithelial neoplasia of the conjunctiva and cornea. Ophthalmology. 1995 Sep;102(9):1338–1344. doi: 10.1016/s0161-6420(95)30866-4. [DOI] [PubMed] [Google Scholar]
  53. Zehetmayer M., Menapace R., Kulnig W. Combined local excision and brachytherapy with ruthenium-106 in the treatment of epibulbar malignancies. Ophthalmologica. 1993;207(3):133–139. doi: 10.1159/000310419. [DOI] [PubMed] [Google Scholar]

Articles from The British Journal of Ophthalmology are provided here courtesy of BMJ Publishing Group

RESOURCES