Conjunctival Squamous Cell Carcinomas (SCCC) are rare neoplasms affecting commonly aged male patients [4,5].
There are several predisposing factors like exposure to ultraviolet-B radiation, HIV/AIDS and other types of immunodeficiencies such as medical immunosuppression, xeroderma pigmentosum and atopic diseases. The aetiological role of human papilloma virus (HPV) has been determined, due to the well-documented role in other lesions of the eye, such as conjunctival papilloma and lacrimal sac neoplasia, and squamous cell carcinomas of the skin [6].
Although it is the most frequently seen malignant neoplasm of the conjunctival epithelium, the literature suggests that it normally behaves in a nonaggressive fashion [5].
The manifestations of SCCC are highly variable and depend on the stage of the tumor. They are sometimes misleading, assuming the appearance of a benign lesion neglected by the patient, resulting in diagnostic and therapeutic delay.
Majority of the patients present with a nodular lesion in the limbus or other parts of the conjunctiva [5]. Most lesions occur in the interpalpebral fissure, especially on the nasal side. Rarely, late presentation with large orbital tumors and diffuse involvement is seen [2]. Invasion deep in the stroma, in the orbit, or in the eye can result in vision loss [7].
Large exophytic tumor, as we saw in our case, is a rare presentation. To our knowledge, large orbital tumor involving the eyeball as the presenting sign of squamous cell carcinoma has not been previously reported.The mean delay of diagnosis is usually 7 months after onset [1]. Our patient sought medical attention at 2 months
after tumor development, but the mass was aggressive enough to cause blindness.
We postulated that the short interval from the tumor’s first appearance to the time the patient seeks medical attention may be explained by rapid growth from strong sunlight exposure in this environment or because of ignorance of the patient at the first appearance of the tumor.
Histopathology is the gold standard for diagnosis [8]. The treatment of conjunctival SCC is wide excision. Enucleation is advised when cornea or sclera has been invaded, and exenteration is recommended in cases of invasion of anterior orbit [9], like in the case of our patient. Exenteration is a radical technique that involves removing all the orbital contents including the periosteum [8].
Metastasis occurs rarely, and commonly parotid or submandibular glands are involved. Even with metastasis, the chance of survival is good [5,10].