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Br J Ophthalmol 2002;86:168-173 doi:10.1136/bjo.86.2.168
  • Original Article
    • Clinical science

Squamous cell carcinoma of the conjunctiva: a series of 26 cases

  1. Penelope A McKelvie1,
  2. Mark Daniell2,
  3. Alan McNab3,
  4. Michael Loughnan3,
  5. John D Santamaria4
  1. 1Department of Anatomical Pathology, St Vincent's Hospital, 41 Victoria Parade, Melbourne, Victoria, 3065, Australia
  2. 2Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, Victoria, 3002, Australia
  3. 3The Royal Victorian Eye and Ear Hospital
  4. 4Intensive Care Unit, Street Vincent's Hospital, Melbourne, Victoria, 3065, Australia
  1. Correspondence to: Penelope McKelvie, Anatomical Pathology, Street Vincent's Hospital, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; mckelvpa.svhm.org.au
  • Accepted 15 August 2001

Abstract

Aim: To retrospectively study 26 patients with squamous cell carcinoma (SCC) of the ocular surface to determine pathological and clinical characteristics of tumour associated with outcome.

Methods: Patients with conjunctival SCC from St Vincent's Hospital and the private ophthalmology practices of the authors were reviewed.

Results: Patents were usually male (77%), elderly (69% > 60 years of age), with most lesions (81%) occurring at the limbus. Seven patients (27%) suffered recurrent ocular surface squamous neoplasia (OSSN) within 4–15 months and two of these patients (8%) died of metastatic disease. Intraocular invasion was noted in three patients (11%), while corneal and/or scleral invasion was found in eight (30%). Orbital invasion was noted in four patients (15%). Six required orbital exenteration. Preoperative impression cytology of five patients with minimally invasive disease showed OSSN in four (80%). In situ carcinoma could not be differentiated from minimally invasive disease using impression cytology. Preoperative diagnosis of SCC was made in 35% of cases. Clinical accuracy was higher for larger lesions (>10 mm) and those with hyperkeratosis.

Conclusions: Conjunctival SCC occurs in sun damaged ocular surface, usually at the limbus in elderly men. Recurrence of OSSN is common with significantly increased risk for older patients, lesions of large diameter, high proliferation index (Ki-67 score), and positive surgical margins. Orbital exenteration may be required for control of local disease and death from metastatic disease occurs in a small percentage of patients.

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