Squamous Cell Carcinoma of Lid
Malignant tumour of squamous layer of cells of the epidermis
Much less common than BCC.
Greater potential for metastasis
Affects elderly, fair-skinned individuals
Usually found on lower eyelid
PATHOGENESIS:
Exact mechanism not known.
Environmental and intrinsic stimuli lead to loss of cell growth and regulation
Most periorbital SCCs arise from actinic lesions, also arise de novo
Environmental factors:
UV exposure
Ionizing radiation
Arsenic ingestion
Psoralen plus UV-A (PUVA) therapy for psoriasis
HPV
Intrinsic factors:
Skin scarring. (Most common)
Xeroderma pigmentosum
Oculocutaneous albinism
Chronic skin dermatoses
Skin ulceration
PRESENTATION:
Erythematous, indurated, hyperkeratotic plaque or nodule with irregular margins
High tendency towards ulceration
Affect eyelid margin and medial canthus
Possibility of perineural invasion and lymphatic spread present
DIAGNOSIS:
Clinical appearance
Confirmed by histological biopsy
PATHOLOGY:
Well-differentiated SCC:
Exhibits polygonal cells with abundant eosinophilic cytoplasm and hyperchromatic nuclei
Dyskeratosis, keratin pearls, intercellular bridges and abnormal mitotic figures are prominent
Poorly-differentiated SCC:
Little keratinization
Fewer intercellular bridges
TREATMENT:
Wide local surgical excision - Moh's technique or under frozen section control
Irradiation
Cryotherapy
Orbital exenteration - if invasion of deep orbital tissue is seen
Image from Rajan Eye Care Hospital
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