Squamous cell carcinoma in the eyelids is similar to that occurring elsewhere on the skin, with low metastatic potential and low tumour-induced mortality. It represents approximately 1-2% of all malignant eyelid lesions. The tumours tend to spread to
Figure 6.4 Complex BCCs, (a) morphoeic (b) fixed to bone (c) medial canthal (d) orbital invasion (e) recurrent after irradiation.
regional nodes but direct perineural invasion into the CNS is usually the cause of death in this group of patients.The tumour occurs with increasing frequency with advancing age. Radiation therapy is a significant aetiologic factor in the production of squamous cell carcinoma.
There is no pathognomonic presentation. These tumours tend to appear as thick, erythematous, elevated lesions with indurated borders and with a scaly surface (Figure 6.5). Cutaneous horn formation or extensive keratinisation are the most consistent features. When it occurs at the eyelid margin the lashes are destroyed. Squamous cell carcinomas may be derived from actinic keratoses. With chronicity and cicatricial changes of the skin, secondary ectropion may occur. The clinical features of the tumour are an exaggeration of those found with actinic keratosis.
Benign tumours such as keratoacanthoma, inverted follicular keratosis, and pseudo epitheliomatous hyperplasia simulate features of squamous cell carcinoma. The common variable with these tumours is inflammation that stimulates epithelial proliferation. Clinically, rapid growth is characteristic of these benign lesions.
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