P 383
Bilateral squamous cell carcinoma of the lids
H. Mittelviefhaus, H. Witschel
Introduction: Within 10 years a 60 years old alcoholic patient developed huge squamous cell carcinoma of his right lower and his left upper lid. Both tumors infiltrated the entire lid.
Case report: Right eye: XII/81 hyperkeratotic seborrheic papilloma of the lower lid. IX/88 rapid growth of an ulcerated lower lid tumor with a deep crater and spontaneous bleeding. The tumor was removed (29x23x13 mm), the lid was reconstructed with a rotation flap and a nasal mucous cartilage composite graft. Left eye: V/98 large ulcerated upper lid and brow tumor (50x30mm) with fixation to the bone and multiple sonographically identified nodules in the left parotic gland and lateral neck (up to 1.5cm). Orbital exenteration, radical parotidectomy and neck-dissection.
Discusion: Due to the rapid growth and the histological pattern of the tumor at the first examination in 1988 a keratoacanthoma was suspected. The diagnoses was supported by the deep crater which was filled with necrotic keratin masses and keratin perls, the sharp margin of the tumor and the moderate cell polymorphism. However, spontaneous bleeding already suggested squamous cell carcinoma. The tumor which invaded the orbit was removed with a safety margin of 5mm. The eye was not enucleated. Histological reevaluation of the tumor 10 years later showed that the immunoinsufficient patient had squamous cell carcinoma not only in his left upper but in his right lower lid as well. Because in 1988 the tumor was removed without orbital exenteration and because the lower lid was reconstructed the patients vision was preserved despite the necessary exenteration of the left orbit.
Conclusion: Immunoinsufficient patients are in danger do develop multiple lid tumors. The difficult differentiation between a squamous cell carcinoma and a keratoakanthoma requires histological sections through the entire tumor and in addition knowledges of the clinical appearance and course. Patients with a squamous cell carcinoma of the lid do have a rather good prognosis if the tumor is removed with a sufficient safety margin.
Univ.-Augenklinik Freiburg, Killianstr. 5, D 79110 Freiburg