Introduction:
Squamous cell carcinoma (SCC) is an uncommon malignant neoplasm of the eyelids comprising 5–10% of all eyelid malignancies.

Methods:
We report an uncommon case of a rapidly growing gargantuan squamous cell carcinoma of the right upper eyelid and its management in an elderly hospice patient.

Results: 
An 84-years-old nonsmoker cognitively-impaired female, with poor functional status (ECOG 3), on hospice care, developed a rapidly growing, foul smelling, painful mass arising from the lateral right upper eyelid within the course of three months. It measured 9 centimeters by 8 centimeters in greatest dimensions, and it interfered with her quality of life, as it was causing complete ptosis impairing her daily activities. Cemiplimab, an anti-PD-1 agent, was initially recommended prior to surgery, but the risk of potential development of an immune-related adverse event in this frail elderly woman outweighed the potential benefits. After addressing goals of care with her family, the decision was made to proceed with radical wide excision of the tumor with repair with a cervicofacial flap. Excisional biopsy showed moderately differentiated squamous cell carcinoma invasive to subcutis without any lymphovascular invasion. The patient was discharged to home hospice three days later in stable conditions and asymptomatic.

Conclusions:
Squamous cell carcinoma in the eyelid occurs much less common than basal cell carcinoma, but are more aggressive and invasive, and can metastasize and invade the orbital and intracranial structures. Addressing goals of care is of utmost importance when formulating a plan of care especially in elderly frail patients.

A RAPIDLY GROWING GIGANTIC SQUAMOUS CELL CARCINOMA OF THE UPPER EYELID IN AN ELDERLY HOSPICE PATIENT