Assess any suspicion of orbital involvement with orbital imaging studies. Most squamous cell carcinomas have a gelatinous surface on gross inspection, which frequently is permeated by fibrovascular cores, giving it a papillomatous appearance. On histologic examination, the full thickness of the epithelium is replaced by atypical, pleomorphic epithelial cells. By definition, the epithelial basement membrane layer is invaded by malignant cells, with involvement of the subepithelial tissues, and possibly adjacent eye, eyelids, and orbit. Metastasis, although rare, may occur.
Excisional biopsy is the treatment of choice.
Removal of a cuff of normal conjunctival tissue surrounding the lesion is prudent, and an episclerectomy at the base of the lesion is also advisable if it is adherent to the sclera in order to remove any superficial cells infiltrating the sclera. The tissues superficial to the Bowman layer are removed easily in a single sheet and sent to the laboratory for analysis. Care should be taken not to incise into the Bowman membrane. Cryotherapy is performed, in a double freeze-thaw manner, to the edges of the uninvolved conjunctiva and Tenon capsule. It also can be applied to the involved limbal area.