Dr. Agarwal and colleagues respond to article with their experience with eye sockets and new cancer formation.

We read with interest the excellent article by Nguyen et al.1 describing 2 patients with conjunctival squamous cell carcinoma in an anophthalmic socket. We, too, have a 75-year-old Latino male patient who presented in February 2007 with a large socket mass approximately 1 cm over the conjunctiva. An enucleation had been performed at 12 years of age secondary to trauma, and he had been wearing an ocular prosthesis since that surgery. A biopsy performed in the clinic revealed squamous cell carcinoma.

The patient underwent a left orbitotomy with resection of the tumor with negative frozen sections, and the orbit was reconstructed. Pathology revealed poorly differentiated squamous cell carcinoma. The patient failed to undergo subsequent radiation treatment as planned and was lost to follow-up for 1 year. The patient then presented with an indurated mass in the left socket. Maxillofacial CT confirmed a locally invasive orbital mass completely obliterating the orbit and extending to involve the preseptal soft tissues, superior and lateral rectus muscles, and lacrimal fossa. The patient underwent an extensive left orbital exenteration with grafting.

He is currently undergoing orbital radiation.

Our patient did not have several of the identifiable risk factors in the development of conjunctival squamous cell carcinoma, such as actinic damage,2,3 human papilloma virus infection,4 immunocompromised state such as in HIV,5 or a history of smoking.6 Chronic irritation from ocular prosthesis wear has been hypothesized to play a part in the development of conjunctival neoplasia.7 As in Dr. Nguyen’s 2 patients, chronic irritation was the only identifiable risk factor. Ophthal Plast Reconstr Surg, Vol. 25, No. 3, 2009 Letters to the Editor