All skin cancers are not created equal

Gokmen Soysal and Markoc,1 in their paper titled, Invasive squamous cell carcinoma of the Eyelids and Periorbital Region, remind us of the serious nature of squamous cell carcinoma (SCC) and its potential for devastating consequences (see page 325). Early diagnosis remains an important feature of treatment. Aggressive surgical excision, especially when the lesion is small, offers the highest cure rate. Preventative measures and newer treatment modalities may offer some prophylaxis.

How serious is cutaneous SCC? 60 000 new cases of skin cancer are diagnosed each year in the UK.2 Over one million new cases of skin cancer are diagnosed each year in the United States.3 These include basal cell carcinoma (BCC), SCC, melanoma and sebaceous cell carcinoma. BCC and SCC, both having a similar etiologic relationship to actinic damage, are collectively, referred to as nonmelanotic skin cancers (NMCC) and represent the most common form of cancer today. UV exposure has been shown to be a risk factor for cutaneous melanoma also. It is estimated that 50% of adults will have a NMCC by age 65.4 BCC represent more than 90% of these tumors. SCC, however, is a much more aggressive and potentially invasive neoplasm.

Gokmen Soysal and Markoc report on 76 patients with periorbital SCC. Orbital invasion was present in a large percentage of patients: 33/76 patients (43.4%). Of these 7/33 had paranasal sinus extension as well. Intracranial involvement was present in 1 patient. Lymph node involvement was seen in 6.6% of patients. Other recent reports show high morbidity, although not as high as shown by Gokmen Soysal and Markoc. Donaldson et al5 reported on 50 cases of SCC of the eyelids. Orbital invasion was found in …