title: Squamous cell carcinoma of the conjunctiva: a series of 26 cases.
abstract: OBJECTIVE
  To retrospectively study 26 patients with squamous cell carcinoma (SCC) of the ocular surface to determine pathological and clinical characteristics of tumour associated with outcome.
  
  
  METHODS
  Patients with conjunctival SCC from St Vincent's Hospital and the private ophthalmology practices of the authors were reviewed.
  
  
  RESULTS
  Patents were usually male (77%), elderly (69% > 60 years of age), with most lesions (81%) occurring at the limbus. Seven patients (27%) suffered recurrent ocular surface squamous neoplasia (OSSN) within 4-15 months and two of these patients (8%) died of metastatic disease. Intraocular invasion was noted in three patients (11%), while corneal and/or scleral invasion was found in eight (30%). Orbital invasion was noted in four patients (15%). Six required orbital exenteration. Preoperative impression cytology of five patients with minimally invasive disease showed OSSN in four (80%). In situ carcinoma could not be differentiated from minimally invasive disease using impression cytology. Preoperative diagnosis of SCC was made in 35% of cases. Clinical accuracy was higher for larger lesions (>10 mm) and those with hyperkeratosis.
  
  
  CONCLUSIONS
  Conjunctival SCC occurs in sun damaged ocular surface, usually at the limbus in elderly men. Recurrence of OSSN is common with significantly increased risk for older patients, lesions of large diameter, high proliferation index (Ki-67 score), and positive surgical margins. Orbital exenteration may be required for control of local disease and death from metastatic disease occurs in a small percentage of patients.
authors.affiliation: Department of Anatomical Pathology, St Vincent's Hospital, 41 Victoria Parade, Melbourne, Victoria, 3065, Australia.
authors.forename: Penelope A
authors.initials: PA
authors.lastname: McKelvie
authors.forename: Mark
authors.initials: M
authors.lastname: Daniell
authors.forename: Alan
authors.initials: A
authors.lastname: McNab
authors.forename: Michael
authors.initials: M
authors.lastname: Loughnan
authors.forename: John D
authors.initials: JD
authors.lastname: Santamaria
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D003230:Conjunctival Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome