Two extremes of the clinical spectrum of conjunctival squamous cell carcinoma presenting in the same patient

Description

A black man aged 61 years with AIDS presented in our institution in 2013 with extensive left-sided orbital soft tissue necrosis and exposure of deep orbital structures, with left eye (LE) destruction caused by squamous cell carcinoma (SCC) (figure 1A). He had a history of biopsy-proven conjunctival SCC in LE, diagnosed in 2010. T2-weighted MRI demonstrated total left orbital invasion (figure 1B), with extension to paranasal sinuses, extensive bone destruction and extension to cavernous sinus. Oncologists decided to treat with palliative radiotherapy (RT, 20 Gy in 5 fractions) followed by orbital exenteration. Ophthalmological evaluation showed suspicious conjunctival lesions with corneal invasion and a gelatinous appearance in the right eye (RE), highly atypical for pterygium (figure 2A). Excisional biopsy was performed and the histological examination showed in situ SCC (figure 2B, C). The patient was treated with adjuvant topical mitomycin...

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