Orbital invasion routes of non-melanoma skin cancers and survival outcomes

Primary periocular squamous cell carcinoma in central Spain: Factors related to recurrence

PURPOSE

To describe the characteristics and recurrence rates of primary periocular squamous cell carcinoma (SCC) in Spain.

METHODS

This retrospective study investigates the characteristics of primary periocular SCC at two tertiary centers in Spain from 2000 to 2020. Data were collected on demographics, skin phenotype, location, clinical and histological diagnosis, the commitment of surgical margins, recurrence, and risk factors. Multivariate analysis and risk factors were used to investigate recurrence rates, considering p < 0.05 as statistically significant.

RESULTS

Over the 20-year studied period, 107 patients with primary periocular SCC were assessed. The mean age of SCC was 76.8 ± 12.8 years, 55 (50.9%) were females, and 105 (98.1%) had Fitzpatrick skin phenotype type II or III. SCC lesions affected less than 1/3 of the eyelid (56/52.3% cases), mainly the lower lid (42/39.3% lesions). Sixty (56.1%) cases were SCC differentiated, 76 (71%) had clear margins. Clinical diagnosis of SCC corroborated with histological in 84 (78.5%) cases and orbital involvement occurred in 18 (16.8%) cases. Recurrence was observed in 13 (12.1%) cases, occurring more in large tumors and undifferentiated subtype (53.8%), with committed margins (69.2%) (p = 0.001), being the commitment of margins a significant predictor for recurrence, although thickness was an independent predictor.

CONCLUSION

Periocular SCC in Spain showed a similar pattern as in the world. The risk of recurrence is increased in undifferentiated and large periocular SCC, partially removed with committed margins.

Escaping from the hunt

A 69-year-old woman presented with chronic, painful, progressive binocular diplopia. Examination showed deficits in multiple sequential cranial nerves (II, III, IV, V_1,2,3, and VI). She was initially diagnosed with Tolosa-Hunt syndrome and had a partial response to systemic corticosteroids. Skull base biopsy eventually showed poorly differentiated carcinoma consistent with perineural spread of squamous cell carcinoma.

Cystic squamous cell carcinoma of the orbit

Both primary and secondary squamous cell carcinoma (SCC) of the orbit are rare entities, though cystic SCC is even more so. It may provide a significant diagnostic conundrum to oculoplastic surgeons. We present a case of an 86 year old male with a supero-medial transilluminating cystic lesion of the orbit. There was a preceding history of a moderately differentiated SCC of the cheek, excised 3 months prior. Computed tomography (CT) demonstrated no bone erosion. The cyst was excised aided by fibrin glue. This demonstrated a poorly differentiated cystic SCC with perineural infiltration. The patient elected for palliative aspirations of the cyst and is alive 12 months later. Cystic SCC of the orbit may present to a number of specialties, including maxillofacial and orbital surgeons. Both diagnosis and management may be challenging. We review common patterns in previous cases and discuss management.