Aim: The aim of this study is to present the clinical and histopathological features as well as the treatment results of advanced conjunctival malignant tumors with orbital invasion, in the context of all secondary orbital tumors. Methods: A total of 151 secondary orbital tumors were observed over a 10-year period; 21 (14%) out of 151 cases were detected to be of conjunctival origin, and the cases were reviewed retrospectively. The age, gender, duration of symptoms, clinical and histopathological features and the treatment results of patients were recorded. Results: Four out of 21 patients had malignant melanoma (MM), while 17 had squamous cell carcinoma (SCC) of the conjunctiva. The mean duration of symptoms was 11.3 months in the MM and 18.5 months in the SCC group. Perineural invasion was detected in 1 of the MM and 3 of the SCC cases. The peritumorous inflammation score was higher in the SCC than the MM group (2.2 vs. 1.5). Two patients underwent wide excision with control of the surgical margins and postoperative adjunctive topical chemotherapy. Nineteen patients needed exenteration. Two patients with regional metastasis were treated by radical neck dissection and radiation therapy to the neck. After a mean follow-up time of 35.6 months, no tumor recurrence or tumor-related death was encountered. Seven patients died from non-tumor-related causes. Conclusion: Delay in presentationfor treatment and previous unsuccessful surgery of conjunctival malignant lesions are likely to lead to orbital invasion and loss of the eye. Exenteration is generally needed but margin-controlled wide surgical excision and adjuvant chemotherapy may be curative in selected cases. Early diagnosis and effective treatment of lesions will minimize the mortality rate and morbidity related to the disease.

Keywords:
Conjunctiva, Malignant tumors, Exenteration
1.
Tulvatana W, Bhattarakosol P, Sansopha L, Sipiyarak W, Kowitdamrong E, Paisuntomsung T, Karnsawai S: Risk factors for conjunctival squamous cell neoplasia: a matched case-control study. Br J Ophthalmol 2003;87:396–398.
2.
Johnson TE, Tabbara KF, Weatherhead RG, Kersten RC, Rice C, Nasr AM: Secondary squamous cell carcinoma of the orbit. Arch Ophthalmol 1997;115:75–78.
3.
Shields JA, Bakewell B, Augsburger JJ, Flanagan JC: Classification and incidence of space-occupying lesions of the orbit: a survey of 645 biopsies. Arch Ophthalmol 1984;102:1606–1611.
4.
Gunalp I, Gunduz K: Secondary orbital tumors. Ophthal Plast Reconstr Surg 1997;13:31–35.
5.
Rahman I, Cook AE, Leatherbarrow B: Orbital exenteration: a 13-year Manchester experience. Br J Ophthalmol 2005;89:1335–1340.
6.
Shields JA, Shields CL, De Potter P: Surgical management of conjunctival tumors: the 1994 Lynn B. McMahan Lecture. Arch Ophthalmol 1997;115:808–815.
7.
Brownstein S: Malignant melanoma of the conjunctiva. Cancer Control 2004;11:310–316.
8.
Chalasani R, Giblin M, Conway RM: Role of topical chemotherapy for primary acquired melanosis and malignant melanoma of the conjunctiva and recommendations for treatment. Clin Exp Ophthalmol 2006;34:708–714.
9.
Frucht-Pery J, Rozenman Y, Pe’er J: Topical mitomycin-C for partially excised conjunctival squamous cell carcinoma. Ophthalmology 2002;109:548–552.
10.
Shields CL, Shields JA, Armstrong T: Management of conjunctival and corneal melanoma with surgical excision, amniotic membrane allograft and topical chemotherapy. Am J Ophthalmol 2001;132:576–578.
11.
Shields CL, Demirci H, Marr BP, Masheyekhi A, Mathein M, Shields JA: Chemoreduction with topical mitomycin C prior to resection of extensive squamous cell carcinoma of the conjunctiva. Arch Ophthalmol 2005;123:109–113.
12.
Shields CL, Naseripour M, Shields JA: Topical mitomycin C for extensive, recurrent conjunctival-corneal squamous cell carcinoma. Am J Ophthalmol 2002;133:601–606.
13.
Demirci H, McCormick SA, Finger PT: Topical mitomycin chemotherapy for conjunctival malignant melanoma and primary acquired melanosis with atypia: clinical experience with histopathologic observations. Arch Ophthalmol 2000;118:885–891.
14.
Beutel J, Sommer K, Gottschalk S, Neppert B, Geerling G: Squamous cell carcinoma of the conjunctiva with orbital invasion: orbital exenteration or minimally invasive procedure? Ophthalmologe 2006;103:693–697.
15.
Polito E, Leccisotti A: Primary and secondary orbital melanomas: a clinical and prognostic study. Ophthal Plast Reconstr Surg 1995;11:169–181.
16.
Liarikos S, Rapidis AD, Roumeliotis A, Angelopoulos AP: Secondary orbital melanomas: analysis of 15 cases. J Craniomaxillofac Surg 2000;28:148–152.
17.
Shields JA, Shields CL, Demirci H, Honavar SG, Singh AD: Experience with eyelid-sparing orbital exenteration: the 2000 Tullos O. Coston Lecture. Ophthal Plast Reconstr Surg 2001;17:355–361.
18.
Bowyer JD, Sullivan TJ, Whitehead KJ, Kelly LE, Allison RW: The management of perineural spread of squamous cell carcinoma to the ocular adnexae. Ophthal Plast Reconstr Surg 2003;19:275–281.
19.
Esmaeli B, Ahmadi MA, Gillenwater AM, Faustina MM, Amat M: The role of supraorbital nerve biopsy in cutaneous malignancies of the periocular region. Ophthal Plast Reconstr Surg 2003;19:282–286.
20.
Veness MJ, Biankin S: Perineural spread leading to orbital invasion from skin cancer. Australas Radiol 2000;44:296–302.
21.
Brownstein S: Mucoepidermoid carcinoma of the conjunctiva with intraocular invasion. Ophthalmology 1981;88:1226–1230.
22.
Gamel JW, Eiferman RA, Guibar P: Mucoepidermoid carcinoma of the conjunctiva. Arch Ophthalmol 1984;102:730–731.
23.
Nerad JA: All skin cancers are not created equal. Br J Ophthalmol 2007;91:276–277.
24.
Soysal HG, Markoç F: Invasive squamous cell carcinoma of the eyelids and periorbital region. Br J Ophthalmol 2007;91:325–329.
© 2008 S. Karger AG, Basel
2008
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.