Purpose

Vulval squamous cell carcinoma (SCC) predominantly spreads via the lymphatic system, with haematogenous spread to distant sites being uncommon. When present, metastases most frequently involve the lungs, liver, and bone, with atypical metastatic sites rarely reported. This report describes a rare case of metastatic basaloid SCC of vulval origin involving the orbit, highlighting its clinical, radiological and histopathological features.

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Methods

A 65-year-old Caucasian female presented with rapidly enlarging, non-tender left superior orbital rim lesion associated with progressive left-sided ptosis, enophthalmos and intermittent orbital pain over a 5-week period. Her medical history was significant for stage IIIA poorly differentiated non-keratinising squamous cell carcinoma of the right vulva with prior inguinal lymph node metastasis. She was considered in remission following treatment with chemotherapy, radiotherapy and surgical excision in 2025. Contrast-enhanced computerised tomography scan of the head and orbits revealed a 17 x 27 x 37 mm enhancing superior mass with a central non-enhancing component, extending posteriorly with inferior globe displacement and invasion of the superior extraocular muscles.

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Results

An incisional biopsy demonstrated a basaloid squamous cell carcinoma with morphological and immunohistochemical features similar to her previous vulval and lymph node specimen, consistent with metastatic basaloid SCC of vulval origin involving the orbit. The orbital lesion represented a rare distant metastatic site following prior regional nodal spread. Despite treatment with palliative radiotherapy, the mass demonstrated continued progression.

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Conclusion

Orbital metastasis from vulval SCC is exceptionally rare, and to our knowledge, previously unreported. This case highlights the aggressive metastatic potential of basaloid squamous cell carcinoma and demonstrates that rapidly progressive orbital lesions in patients with a history of vulval malignancy warrant urgent imaging and tissue diagnosis, even in the setting of apparent remission.

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Additional Authors

First name	Last name	Base Hospital / Institution
Sheryll	Kamat	Luton and Dunstable University Hospital
Helena	Fawdry	Luton and Dunstable University Hospital
Dost	Jabarkyl	Luton and Dunstable University Hospital
Susan	Sarangapani	Luton and Dunstable University Hospital
Engin	Akyol	Luton and Dunstable University Hospital

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