Invasive periorbital squamous cell carcinoma

SIR, We report on the case of a 73-year-oId male with ptysis bulbi of the right eye. Histolotiy revealed a squamous cell carcinoma (SCC). .\ 73-year-oi(J niali.prcscntetl to casualty with a 7-month history of progressive ocular and periocular inflammation and infection with discharge, intense pain in the tcmporoparietat region and loss of vision. There was a past history of moderate alcoholism. Physical examination revealed deep ulceration uf the eyeball with loss o( intraocular components (ptysis bulhi), a scropurulent discharge, intense oedema and palpebral and periorbital infiltration (Fig. 1). There was no regional lymphadenopathy. Routine laboratory studies were normal, as was the hepatic ultrasound. Vuclear magnetic resonance scanning (cranium and right orbit; Fig. 2) showed tumour in the external anterior portion of tbe right orbit, measuring 5 X 45 X 6cm, involving botb eyelids, the superficial temporal muscle and the lacrimal gland. The zygomatic arch and the external part of the lamina pap\racea ofthe ethmoids were aftected. Tbe optic nerve was normal and there was no intracranial extension. Staging (T4 N|| i\I||) of the lesion was carried out. Histology of a biopsy of the external cantbus showed an epidermoid tumour. Treatment eonsisted of orbital exenteration v\ith partial upper right maxillectomy and c'thmoidectomy. The patient subsequently received radiation therapy for 5 months. Eighteen months after surgery the orbital cavity was epitbelialized witb no signs of local recurrence or cxtracutaneous disseminated disease.