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Identification of Metastatic Conjunctival Squamous Cell Carcinoma through Neck Palpation
Thamanna Nishath1, Minh T Nguyen1, Michael Wu2
1Department of Ophthalmology, University of Washington, Seattle, Washington, USA.
Abstract:
An 80-year-old male with a distant 10 pack-years smoking history and squamous cell carcinoma (SCCA) of the scalp diagnosed 15 years ago presented with a new right nasal bulbar conjunctival lesion found to be invasive SCCA. The patient was started on interferon alfa-2b for 5 months until there was no evidence of residual disease. During a follow-up visit 10 months after diagnosis and during routine ophthalmic follow-up, an enlarged right submandibular lymph node was found through neck palpation and revealed to be SCCA without extranodal extension. The lesion was likely to have metastasized from his right conjunctival squamous cell carcinoma (CSCCA). Regional lymph nodes are a commonplace of metastasis for CSCCA making neck palpation a reasonable and recommended part of clinical examination to monitor for metastasis. This is the first known case of identifying regional metastasis of CSCCA through neck palpation.
Insights
This case report details the first instance of detecting regional metastasis of conjunctival squamous cell carcinoma (CSCCA) via neck palpation. Early detection through routine examination is crucial for managing this rare cancer spread.
Area of Science:
- Ophthalmology
- Oncology
- Dermatology
Background:
- Squamous cell carcinoma (SCCA) can affect the conjunctiva, the thin membrane covering the eye's white part and inner eyelids.
- Metastasis of conjunctival squamous cell carcinoma (CSCCA) to regional lymph nodes is uncommon but possible.
- Early detection of metastasis is critical for effective treatment and patient outcomes.
Observation:
- An 80-year-old male with a history of scalp SCCA presented with a new invasive SCCA on his right nasal bulbar conjunctiva.
- The patient received interferon alfa-2b treatment, achieving no evidence of residual disease.
- During routine follow-up, an enlarged right submandibular lymph node was detected through neck palpation.
Findings:
- The enlarged lymph node was diagnosed as SCCA without extranodal extension.
- This represents the first documented case of CSCCA metastasis identified through clinical neck palpation.
- The metastasis was presumed to originate from the conjunctival lesion.
Implications:
- Neck palpation should be considered a valuable component of clinical examination for patients with CSCCA to monitor for metastasis.
- This finding highlights the importance of thorough physical examination in identifying metastatic disease.
- Further research may explore the efficacy of neck palpation in the surveillance of CSCCA patients.
