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Gaca PJ, Rejdak R, Lewandowicz M, Kopecky A, Kakkassery V, Heindl LM. Surgical excision of eyelid tumors and subsequent ophthalmoplastic reconstruction. DIE OPHTHALMOLOGIE 2024; 121:23-32. [PMID: 37989962 DOI: 10.1007/s00347-023-01956-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 11/23/2023]
Abstract
In recent years new modern therapeutic concepts have been developed in the treatment of malignant eyelid tumors; however, surgical restoration remains an important component of the therapeutic options addressed, which include microsurgical tumor excision into healthy tissue and subsequent coverage of the defects. An ophthalmic surgeon experienced in oculoplastic surgery is responsible for the recognition and evaluation of the existing alterations and planning a procedure together with the patient that meets the patient's expectations. The planning of surgery must always be individualized and fit the initial findings. Depending on the defect size and localization, different coverage strategies are available to the surgeon. To ensure successful reconstruction, every surgeon should master a wide range of reconstructive techniques.
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Affiliation(s)
- P J Gaca
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, Lublin, Poland.
| | - R Rejdak
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, Lublin, Poland
| | - M Lewandowicz
- Department of Oncological Surgery, Multidisciplinary M. Copernicus Voivodeship Center for Oncology and Traumatology, Lodz, Poland
| | - A Kopecky
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Ophthalmology Clinic, University Hospital Ostrava, Ostrava, Czech Republic
- Medical Faculty, University Ostrava, Ostrava, Czech Republic
| | - V Kakkassery
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - L M Heindl
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne, Duesseldorf, Cologne, Germany
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Gaca PJ, Rejdak R, Lewandowicz M, Kopecky A, Kakkassery V, Heindl LM. [Surgical excision of eyelid tumors and subsequent ophthalmoplastic reconstruction]. DIE OPHTHALMOLOGIE 2023; 120:252-261. [PMID: 36862183 DOI: 10.1007/s00347-023-01824-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 03/03/2023]
Abstract
In recent years new modern therapeutic concepts have been developed in the treatment of malignant eyelid tumors; however, surgical restoration remains an important component of the therapeutic options addressed, which include microsurgical tumor excision into healthy tissue and subsequent coverage of the defects. An ophthalmic surgeon experienced in oculoplastic surgery is responsible for the recognition and evaluation of the existing alterations and planning a procedure together with the patient that meets the patient's expectations. The planning of surgery must always be individualized and fit the initial findings. Depending on the defect size and localization, different coverage strategies are available to the surgeon. To ensure successful reconstruction, every surgeon should master a wide range of reconstructive techniques.
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Affiliation(s)
- P J Gaca
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
- Abteilung für Allgemeine Ophthalmologie und Pädiatrische Ophthalmologie, Medizinische Universität Lublin, Lublin, Polen.
| | - R Rejdak
- Abteilung für Allgemeine Ophthalmologie und Pädiatrische Ophthalmologie, Medizinische Universität Lublin, Lublin, Polen
| | - M Lewandowicz
- Abteilung für onkologische Chirurgie, Multidisziplinäres M. Copernicus Woiwodschaftszentrum für Onkologie und Traumatologie in Lodz, Lodz, Polen
| | - A Kopecky
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
- Klinik für Augenheilkunde, Universitätskrankenhaus Ostrava, Ostrava, Tschechien
- Medinizische Fakultät, Universität Ostrava, Ostrava, Tschechien
| | - V Kakkassery
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - L M Heindl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
- Centrum für Integrierte Onkologie (CIO) Bonn-Düsseldorf-Köln, Köln, Deutschland
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Kopecky A, Rokohl AC, Gaca PJ, Matos PAW, Nemcansky J, Heindl LM. Clinical Signs for Differential Diagnosis of Eyelid Tumours. Klin Monbl Augenheilkd 2023; 240:13-23. [PMID: 36706766 DOI: 10.1055/a-1996-0950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This article aims to present the differential diagnostics of benign and malignant eyelid tumours. The most common malignant eyelid tumour is basal cell carcinoma, followed by squamous cell carcinoma. The common signs of malignity are loss of lashes, ulceration, and infiltration of the lesion. Often the clinical appearance is various and therefore only a histological analysis gives the proper diagnosis. For most tumours, surgical resection is the gold standard of therapy. The reconstruction of the defects should be performed by an experienced oculoplastic surgeon. In malignant tumours that require large safety margins, the defect can be easily very large, and the reconstruction must then be performed with advanced ophthalmic plastic reconstruction techniques.
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Affiliation(s)
- Adam Kopecky
- Ophthalmology Clinic, University Hospital Ostrava, Ostrava, Czech Republic.,Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.,Department of Craniofacial Surgery, University of Ostrava Faculty of Medicine, Olomouc, Czech Republic
| | | | - Piotr Jakub Gaca
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | | | - Jan Nemcansky
- Ophthalmology Clinic, University Hospital Ostrava, Ostrava, Czech Republic.,Department of Craniofacial Surgery, University of Ostrava Faculty of Medicine, Ostrava, Czech Republic
| | - Ludwig M Heindl
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.,Center for Integrated Oncology (CIO) - Aachen - Bonn - Cologne - Düsseldorf, Cologne, Germany
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Effective systemic treatment of advanced periocular basal cell carcinoma with sonidegib. Graefes Arch Clin Exp Ophthalmol 2021; 259:3821-3822. [PMID: 34338845 PMCID: PMC8589764 DOI: 10.1007/s00417-021-05311-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 11/26/2022] Open
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Effective treatment of locally advanced periocular basal cell carcinoma with oral hedgehog pathway inhibitor? Graefes Arch Clin Exp Ophthalmol 2020; 258:2335-2337. [PMID: 32514773 PMCID: PMC7550312 DOI: 10.1007/s00417-020-04779-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 04/29/2020] [Accepted: 06/01/2020] [Indexed: 01/18/2023] Open
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Kakkassery V, Emmert S, Adamietz IA, Kovács G, Jünemann AM, Otte C, Zimbelmann M, Brosig A, Grisanti S, Heindl LM. [Alternative treatment options for periorbital basal cell carcinoma]. Ophthalmologe 2020; 117:113-123. [PMID: 31811367 DOI: 10.1007/s00347-019-01021-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Latest developments as well as established procedures offer alternative treatment approaches to basal cell carcinoma (BCC) when micrographically controlled surgical removal is not a valid option. OBJECTIVE Alternative treatment options for periorbital BCC are presented. METHODS A literature search was carried out and a structured display and analysis of the results are given. RESULTS Micrographically controlled surgical removal represents the gold standard in treatment of BCC. When for various reasons surgical removal is not a valid option, other procedures are required. The alternative treatment options can be divided into three main groups: treatment options for locally advanced or metastasized BCC, topical approaches for small and superficial BCC and prophylactic measures. While radiotherapy and systemic therapy are suitable for locally advanced BCC and are discussed in a tumor board, small and superficial BCC can be treated by topical medication. In cases of a previous BCC history, a prophylactic treatment can be considered. Combinations of systemic treatment and also neoadjuvant or adjuvant approaches before and after surgery are promising options for a successful outcome, which can further improve the standard treatment for locally advanced BCC. CONCLUSION Alternative treatment options for periocular BCC are available; however, the use is only indicated when microscopically controlled excision with subsequent oculoplastic reconstruction is not possible. According to the national guidelines a prior presentation to a suitable tumor board is practically compulsory.
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Affiliation(s)
- Vinodh Kakkassery
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - Steffen Emmert
- Klinik und Poliklinik für Dermatologie, Universitätsmedizin Rostock, Rostock, Deutschland
| | | | - György Kovács
- Gemelli INTERACTS - Università Cattolica del Sacro Cuore, Rom, Italien.,Bereich Interdisziplinäre Brachytherapie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Anselm M Jünemann
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Caroline Otte
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Michael Zimbelmann
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Anton Brosig
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Salvatore Grisanti
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Ludwig M Heindl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland
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[Surgical resection with ophthalmoplastic reconstruction : Gold standard in periocular basal cell carcinoma]. Ophthalmologe 2020; 117:95-105. [PMID: 31562561 DOI: 10.1007/s00347-019-00973-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The gold standard for the treatment of periocular basal cell carcinoma is surgical resection followed by ophthalmoplastic reconstruction. The highest priority in most cases is the complete histopathologically controlled tumor excision. The histopathological preparation can be carried out in two stages by rapid overnight embedding or intraoperatively by a rapid frozen section procedure. A variety of reconstruction methods enable a customized and in most cases also a cosmetically and functionally attractive defect coverage. Postoperatively, a regularly performed tumor aftercare is essential.
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