A 59 year-old otherwise healthy women presented with a 6 month history of slowly growing erythematous plaque on the right upper eyelid. A biopsy was performed and interpreted as squamous cell carcinoma in situ. Mohs micrographic surgery was attempted. During procedure, the surgeon realized that unlike typical squamous cell carcinoma, the tumor extensively involved conjunctiva and the clear margins could not be achieved in spite of multiple layers.
The Mohs surgery was stopped and the bulk tissue was thawed and submited for consultation with request to re-review the original biopsy.
Clinical pictures are courtesy of Dr. Emily Fisher, M.D., Lahey Clinic, Burlington, MA.