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Massive Periocular Squamous Cell Carcinoma With Response to Pembrolizumab (Keytruda)

Conger, Jordan R. M.D.; Grob, Seanna R. M.D., M.A.S.; Tao, Jeremiah M.D.

Ophthalmic Plastic & Reconstructive Surgery: September/October 2019 - Volume 35 - Issue 5 - p e127
doi: 10.1097/IOP.0000000000001351
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Oculofacial Plastic and Orbital Surgery, Gavin Herbert Eye Institute University of California, Irvine, California, U.S.A.

Accepted for publication February 2, 2019.

Dr. Jordan R. Grob involved in Heed Ophthalmic Fellowship. The other authors have no conflicts of interest to disclose.

Address correspondence and reprint requests to Jordan R. Conger, M.D., 850 Health Sciences Road, Irvine, CA 92697. E-mail:

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An 87-year-old woman presented with worsening right facial and periocular pain due to a large facial mass. She was diagnosed with squamous cell carcinoma 1.5 years before and received radiation therapy at an outside institution. Examination revealed a large 10 × 11 cm ulcerative facial lesion over the right temporal region extending to the lateral canthus with proptosis (Fig. A). Silver nitrate can be seen atop the lesion. Extraocular motility showed severe limitation in all directions. Imaging demonstrated tumor in the orbit, through the skull base, and down to the temporal lobe of the brain. Histopathologic analysis from previous biopsy demonstrated a well-differentiated invasive squamous cell carcinoma with keratoacanthomatous features. Given the extent of the lesion, poor overall physical condition, and advanced age, the patient opted for nonoperative care. In an attempt to palliate this invasive tumor, the patient received 8 infusions of pembrolizumab (Keytruda; anti-PD1, immunotherapy agent). Six months after, external examination showed significant regression of the lesion with cicatrization down to the temporal fossa with an exposed, escharred lateral zygomatic arch and lateral frontal bone (Fig. B).



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