Secondary squamous cell carcinoma of the orbit
T. E. Johnson, K. F. Tabbara, R. G. Weatherhead, R. C. Kersten, C. Rice and A. M. Nasr
King Khaled Eye Specialist Hospital, King Saud University, Riyadh, Saudi Arabia. 75112.2464@compuserve.com
OBJECTIVE: To evaluate the origin and biological behavior of secondary
orbital squamous cell (SCC) and mucoepidermoid carcinoma. METHODS: A
retrospective review of 30 consecutive patients with SCC and mucoepidermoid
carcinoma of the orbit seen over a period of 8 years at a large ophthalmic
hospital in Saudi Arabia. RESULTS: A total of 51 secondary orbital tumors
were seen in the 8-year period from 1983 through 1991; 30 (60%) of the 51
cases were SCC. There were 16 male and 14 female patients, with an age
range of 38 to 80 years and a mean age of 65 years. In 28 (93%) of the 30
patients, the tumor originated in the conjunctiva. Orbital involvement by
conjunctival SCC was the most common cause of secondary orbital tumors
encountered in patients older than 19 years. Four patients had concomitant
paranasal sinus involvement, 4 patients exhibited intraocular invasion, and
2 others were found to have intracranial extension of the SCC. Six (20%) of
the 28 patients developed regional lymph node metastases during the course
of their illness. All patients were treated by orbital exenteration, with
or without radiation therapy. Seven (23%) of the 28 patients died of their
disease. CONCLUSIONS: Orbital SCC is an aggressive and life-threatening
condition. Most cases result from secondary extension of conjunctival SCC,
a common disease in Saudi Arabia. Several factors contribute to the
aggressiveness of conjunctival SCC in this geographic location, including
continual exposure to UV rays, chronic irritation, and genetic factors.
Delay in presentation for treatment, inadequate initial resection of
conjunctival lesions, and the aggressive mucoepidermoid carcinoma variant
of SCC are also factors contributing to orbital invasion.
