Orbital exenteration for invasive skin tumours

Oculoplastic aspects of ocular oncology

It is estimated that 5-10% of all cutaneous malignancies involve the periocular region and management of periocular skin cancers account for a significant proportion of the oculoplastic surgeon's workload. Epithelial tumours are most frequently encountered, including basal cell carcinoma, squamous cell carcinoma, and sebaceous gland carcinoma, in decreasing order of frequency. Non-epithelial tumours, such as cutaneous melanoma and Merkel cell carcinoma, rarely involve the ocular adnexae. Although non-surgical treatments for periocular malignancies are gaining in popularity, surgery remains the main treatment modality and has as its main aims tumour clearance, restoration of the eyelid function, protection of the ocular surface, and achieving a good cosmetic outcome. The purpose of this article is to review the management of malignant periocular tumours, with particular emphasis on surgical management.

Subconjunctival "ring" recurrence of Basal cell carcinoma of the globe

Basal cell carcinoma is the most common indication for orbital exenteration. The recurrence rate of BCC removed with microscopically controlled histology sections is up to 6%. The authors describe the recurrence of a lower eyelid BCC resected with microscopic control that did not manifest itself until 15 years later as a subconjunctival lesion, encircling the globe, and without apparent skin involvement. BCC can present in any manner following surgery, and therefore, judicious follow-up is necessary even after microscopically controlled resection.

Microvascular reconstruction of the orbital complex

Extensive skin, paranasal, and skull base malignancies often invade the orbit necessitating the removal of the orbital contents to achieve local tumor control. Defects of this region often create a communication between the intracranial and extracranial contents that involves a large volume of skin, soft tissue, and bone. Local and regional tissue alone is rarely adequate to repair these defects. In contrast, free tissue transfer can provide vascularized skin, soft tissue, and bone that can reliably separate the extracranial and intracranial compartments and restore the bony and soft tissue architecture of the orbitomaxillary complex. This article summarizes the approach to orbitomaxillary reconstruction and discusses the use of free tissue transfer in the rehabilitation of this complex region.