Rapid recurrence of papillary squamous cell carcinoma of the canaliculus

We treated a 76-year-old man who had an epithelial carcinoma that involved the canaliculus and extended into the lacrimal sac. Despite what appeared to be adequate resection (the surgical margins were completely free of tumor on both frozen and paraffin section), the tumor recurred less than one month later. The patient underwent wide local incision, including en bloc removal of the medial third of both eyelids and inner canthi, canaliculi, lacrimal sac, and nasolacrimal duct, and resection of the anterior lacrimal crest, lacrimal bone, anterior portion of the ethmoid bone, anterior medial wall of the maxilla, and subjacent periosteum and mucous membranes. Sixteen months later, the tumor has not recurred. This infiltrating papillary squamous cell carcinoma histologically demonstrated the most rapid and destructive recurrence of any such tumor originating in the lacrimal system.