title: Conjunctival squamous cell carcinoma arising in immunosuppressed patients (organ transplant, human immunodeficiency virus infection).
abstract: OBJECTIVE
  To describe the relationship between chronic systemic immune suppression and conjunctival squamous cell carcinoma (SCC).
  
  
  METHODS
  Retrospective interventional case series.
  
  
  METHODS
  Thirteen immunosuppressed patients with conjunctival SCC.
  
  
  METHODS
  Surgical excision in all cases plus additional topical interferon alpha-2B or mitomycin.
  
  
  METHODS
  Tumor control.
  
  
  RESULTS
  There were 3 groups of patients with chronic immunosuppression and conjunctival SCC, including 8 patients who received an organ transplant, 4 patients with human immunodeficiency virus (HIV), and 1 patient with systemic lupus erythematosus (SLE) receiving long-term corticosteroids. The transplanted organ was kidney (n=4) (1 with additional pancreas transplant), lung (n=2), liver (n=1), and heart (n=1). The mean patient age at presentation for the organ transplant group was 60 years, and the mean interval from transplant to conjunctival SCC was 8.2 years. Management included surgical excision (n=8) plus additional topical interferon alpha-2B (n=3) and mitomycin C (n=1). Three patients showed aggressive recurrence or new tumor, and 1 patient died of brain invasion of SCC. In the HIV group, the mean patient age at presentation was 54 years and the mean interval from HIV diagnosis to conjunctival SCC was 5 years. Management included surgical excision (n=5) plus additional topical interferon alpha-2B (n=3) and mitomycin C (n=1). One patient showed aggressive extensive recurrence requiring enucleation and radiotherapy, and there were no related deaths. The patient with SLE was 49 years old, had been taking systemic corticosteroids for 18 years, and showed control with surgical resection and topical interferon alpha-2B. Of the 5 patients treated with excision and prompt topical interferon alpha-2B, none showed recurrence or new tumor.
  
  
  CONCLUSIONS
  Conjunctival SCC can occur in immunosuppressed patients and can be more aggressive and invasive, requiring enucleation or exenteration. Surgical resection plus topical interferon alpha-2B might reduce the risk for recurrence or new tumor.
  
  
  BACKGROUND
  The author(s) have no proprietary or commercial interest in any materials discussed in this article.
authors.affiliation: Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. shields@shieldsoncology.com
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
authors.forename: Aparna
authors.initials: A
authors.lastname: Ramasubramanian
authors.forename: Phoebe L
authors.initials: PL
authors.lastname: Mellen
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Shields
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D003230:Conjunctival Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000276:immunology; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D015497:HIV-1 / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000276:immunology; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D016377:Organ Transplantation; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D016685:Mitomycin