Management of periocular squamous cell carcinoma is challenging because of the need for adjunctive therapy, the adverse effects of therapies and the frequent recurrence of SCC. Appropriate treatment of equine ocular SCC usually involves surgical excision combined with adjunctive therapy selected as appropriate for the anatomic site of the lesion. Metastasis of periocular SCC has been reported to occur in approximately 6–15% of cases. The horse owner should be carefully educated to understand that for best long-term results from the treatment of periocular SCC, they must be diligent in observing signs of recurrence or metastasis and be willing to have the horse examined as soon as adverse signs are observed. Furthermore, external beam radiation may be effective in the treatment of metastatic SCC and further clinical studies of this treatment modality are needed.