Squamous cell carcinoma of conjunctiva

Question 1

What is squamous cell carcinoma (SCC)?

Answer 1

Rare malignancy that is part of the spectrum of ocular surface squamous neoplasia.

Malignant neoplasm of the stratified squamous epithelium of the conjunctiva.

Question 2

Define conjunctival intraepithelial neoplasia.

Answer 2

Localized/diffuse replacement of normal conjunctiva epithelium by malignant cells derived from the stratified squamous

Question 3

Define SCC in situ

Answer 3

Neoplastic cells replace full thickness epithelium but do not invade the substantia propria

Question 3

Define conjunctival squamous epithelial dysplasia.

Answer 3

Malignant cells involve only a portion of the thickness of epithelium

Question 4

Name and describe the 3 types of SCC of the conjunctiva.

Answer 4

1. Leukoplakic tumour- Hard, white accumulation of abnormally keratinized conjunctival epithelium
2. Papillary tumor- Appears as pink to reddish mass that exhibits prominent vascular loops internally on slit lamp
3. Gelatinous tumor- Appears as translucent nodule fed and drained by prominent dilated epibulbar blood vessels

Question 5

Give 4 modifiable risk factors of SCCC.

Answer 5

• Increased exposure to uv radiation
• infections :HIV,HPV
• Allergic conjunctivitis
• Outdoor occupations
• Cigarette smoking

Question 6

Give 3 non-modifiable risk factors of SCCC.

Answer 6

• Male gender
• History of squamous cell carcinoma of the head and neck
• Blonde hair and light complexion

Question 7

What the clinical features of SCCC?

Answer 7

• A white bulging painless mass with an irregular surface
  Lesion can be pigmented especially in equatorial populations
  Feeder vessel is often present
  Mostly located in the (nasal)interpalpebral fissure
  Typically unilateral
• Signs of ocular inflammation
  Redness and tearing
  Blurry vision
  photophobia

Question 8

Give 5 differential diagnosis for SCCC.

Answer 8

• Actinic keratosis
• Benign intraepithelial dyskeratosis
• Conjunctival/tarsal cyst
• Keratoacanthoma
• Malignant melanoma
• Pterygium

Question 9

How is a SCCC lesion described?

Answer 9

Cauliflower lesion

Question 10

What is the gold standard investigation for SCCC?

Answer 10

Histopathology following excisional biopsy is the gold standard

Question 11

What is the gold standard management for SCCC?

Answer 11

Gold standard treatment. Assists in tissue diagnosis .excisional or incisional biopsy allow for tumor removal and also histopathological analysis.

Surgical excision with subsequent radiation

Large lesions might require exenteration