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Chebib E, Rougier G, Dubray-Vautrin A, Martin J, Ghanem W, Lesnik M, Sabran B, Matet A, Malaise D, Cassoux N, Dendale R, Choussy O, Badois N. Lymph Node Evolution in Eyelid and Orbit Squamous Cell Carcinomas. Laryngoscope 2024. [PMID: 39031611 DOI: 10.1002/lary.31584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 04/04/2024] [Accepted: 05/22/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVES To describe a large cohort of eyelid and periorbital SCCs, to compare the location of the tumor and of the pathological lymph nodes, and to analyze the risk factors for lymph node involvement among tumor characteristics. METHODS All patients managed inside our institution for an eyelid and periorbital SCCs were included. Tumor characteristics, imaging setup, excision margins, lymph node evolution features, local, regional, and distant recurrences rates, and global survival were reported. The risk for lymph node involvement and location of pathological lymph nodes were analyzed through univariate and multivariate analyses. RESULTS Between January 2012 and August 2022, 115 patients were included, and 18 presented a lymph node evolution (15.7%), involving the parotid gland in 16 cases (88.9%), the submental and submandibular areas in seven cases (38%), and the jugular and carotid areas in four cases (22%). Tumor size above 20 mm, infiltration of the external canthus and periorbital structures, the presence of perineural invasion or vascular embolism, the depth of infiltration, and the presence of a local recurrence were significantly associated with the risk of lymph node evolution. CONCLUSION Periorbital and eyelid SCCs present a true potential for lymph node evolution especially through the parotid gland. Extension setup including the parotid gland and neck should be mandatory, and lymph node dissection should be associated in case of parotidectomy for lymph node involvement. LEVEL OF EVIDENCE IV Laryngoscope, 2024.
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Affiliation(s)
- Emilien Chebib
- Head & Neck Oncologic and Reconstructive Surgery Department, Institut Curie, Ear, Nose & Throat, Paris, France
| | - Guillaume Rougier
- Head & Neck Oncologic and Reconstructive Surgery Department, Institut Curie, Ear, Nose & Throat, Paris, France
| | - Antoine Dubray-Vautrin
- Head & Neck Oncologic and Reconstructive Surgery Department, Institut Curie, Ear, Nose & Throat, Paris, France
| | - Joey Martin
- Head & Neck Oncologic and Reconstructive Surgery Department, Institut Curie, Ear, Nose & Throat, Paris, France
| | - Wahib Ghanem
- Head & Neck Oncologic and Reconstructive Surgery Department, Institut Curie, Ear, Nose & Throat, Paris, France
| | - Maria Lesnik
- Head & Neck Oncologic and Reconstructive Surgery Department, Institut Curie, Ear, Nose & Throat, Paris, France
| | - Baptiste Sabran
- Head & Neck Oncologic and Reconstructive Surgery Department, Institut Curie, Ear, Nose & Throat, Paris, France
| | - Alexandre Matet
- Ophthalmology and Ocular Oncology Department, Institut Curie, Paris, France
- Université Paris Cité, Paris, France
| | - Denis Malaise
- Ophthalmology and Ocular Oncology Department, Institut Curie, Paris, France
| | - Nathalie Cassoux
- Ophthalmology and Ocular Oncology Department, Institut Curie, Paris, France
- Université Paris Cité, Paris, France
| | - Rémi Dendale
- Radiation Oncology Department, Institut Curie, Paris, France
| | - Olivier Choussy
- Head & Neck Oncologic and Reconstructive Surgery Department, Institut Curie, Ear, Nose & Throat, Paris, France
| | - Nathalie Badois
- Head & Neck Oncologic and Reconstructive Surgery Department, Institut Curie, Ear, Nose & Throat, Paris, France
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Dini F, Susini P, Zuccaro B, Nisi G, Cuomo R, Grimaldi L, Perillo G, Tinunin L, Antonini P, Innocenti A, Cecchi G, Gambale E, Doni L, Mazzini C, Santoro N, De Giorgi V. Head and neck melanoma: the eyelid region has a better prognosis and easier management: a retrospective survey and systematic review. Melanoma Res 2024:00008390-990000000-00152. [PMID: 38833343 DOI: 10.1097/cmr.0000000000000984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Eyelid melanoma (EM) is a malignant neoplasm accounting for around 1% of eyelid malignancies. Because of its rarity, most of our knowledge of EM is currently based on studies of cutaneous melanomas located elsewhere. Accordingly, this study aimed to specifically evaluate EM characteristics, management strategies, and prognosis. A retrospective study was carried out on patients diagnosed with EM at Careggi University Hospital, Florence between May 2012 and May 2022. In addition, a systematic review of relevant literature was conducted, encompassing studies published from 2013 to 2023. Clinical, histopathological, therapeutical, and prognostic data were analyzed to assess the metastasis rate and the 5-year survival rate of patients with EM. Separate data were extracted for in situ and invasive disease. Our original study included 19 patients diagnosed with EM with a 5-year survival rate of 100% for in situ and 83.3% for invasive EM. The literature review identified five poorly detailed large database reviews and 14 original studies on EM with an overall 5-year survival rate of 79.7%. The present research indicates that EM is a challenging malignancy, but has a relatively better prognosis and easier management than other melanomas of the head and neck region. These are probably related to the anatomical location which leads to early diagnosis. Therefore, EM should be considered as a specific disease requiring dedicated treatment. Based on the personal authors' experience and comprehensive overview of the current knowledge, a dedicated protocol is proposed.
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Affiliation(s)
- Federica Dini
- Department of Neurosciences, Psychology, Drug Research and Child Health Eye Clinic, University of Florence, Florence
- Plastic Surgery Unit, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena
| | - Pietro Susini
- Plastic Surgery Unit, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena
| | | | - Giuseppe Nisi
- Plastic Surgery Unit, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena
| | - Roberto Cuomo
- Plastic Surgery Unit, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena
| | - Luca Grimaldi
- Plastic Surgery Unit, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena
| | | | - Luca Tinunin
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence
| | - Pietro Antonini
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona, Verona
| | | | | | | | - Laura Doni
- Clinical Oncology Unit, Careggi University Hospital
| | - Cinzia Mazzini
- Unit of Ocular Oncology, Department of Neuromuscular and Sense Organs
| | - Nicola Santoro
- Unit of Ocular Oncology, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy
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Bergmann MJ, de Keizer ROB, Paridaens D. Globe-sparing surgical treatment for periocular malignancies with anterior orbital invasion: a consecutive case series. Orbit 2023; 42:536-544. [PMID: 36617852 DOI: 10.1080/01676830.2022.2141803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/25/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Orbital exenteration of periocular tumors complicated by orbital invasion is a heavy burden for patients and leads to disfiguring cosmesis and loss of vision. Here, we report our experience with globe-sparing surgery in a series of patients with periocular malignancies other than basal cell carcinoma (BCC), all exhibiting anterior orbital invasion. METHODS In this consecutive case series, we examined medical records of all patients between 2000 and 2018 with periocular malignancies (other than BCC) invading the anterior orbit (without extraocular muscle or scleral invasion) treated by one orbital surgeon (DP). The main outcome measures included local recurrence, regional and distant metastasis, survival, and visual acuity. RESULTS Nine patients were identified. Of the non-BCC cancers invading the orbit, squamous cell carcinoma (SCC) (44.4%) was the most prevalent type in our series. Excision included the removal of visibly distinguishable tumor and a free clinical margin of up to 5 mm with histological confirmation of radicality of the invasive tumor component. Reconstruction was achieved by a variety of oculoplastic reconstructive procedures. At a mean follow-up of 70 months (range 11-177 months), 8 out of 9 patients were still alive. Recurrence occurred in two patients with conjunctival melanoma (CM), and they were again treated with wide excision. Postoperative visual acuity remained stable or improved. CONCLUSION This retrospective case series demonstrates that globe-sparing excisional surgery can be considered in selected cases of periocular malignancies other than BCC with anterior orbital invasion, thus avoiding cosmetic disfigurement and loss of vision due to orbital exenteration.
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Affiliation(s)
- Michael Jan Bergmann
- Department of Orbital Oculoplastic and Lacrimal Surgery, The Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | - Ronald Olaf Björn de Keizer
- Department of Orbital Oculoplastic and Lacrimal Surgery, The Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | - Dion Paridaens
- Department of Orbital Oculoplastic and Lacrimal Surgery, The Rotterdam Eye Hospital, Rotterdam, The Netherlands
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Single-staged Tunneled Forehead Flap for Medial Canthal and Eyelid Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4223. [PMID: 35475283 PMCID: PMC9029905 DOI: 10.1097/gox.0000000000004223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/20/2022] [Indexed: 11/29/2022]
Abstract
Purpose: The paramedian forehead flap, while initially used for reconstruction of nasal defects, has been adapted for repair of anatomical subunits in the medial canthal and eyelid area. A significant obstacle for utilizing the flap has been the bulky, unsightly vascular pedicle that is maintained between surgical stages. We describe our surgical experience using the tunneled variation in a single stage procedure. Methods: A retrospective chart review was performed of three surgeons’ charts over a 5-year period. All patients who underwent the tunneled paramedian forehead flap variation were selected. Outcomes measured included underlying pathology, Mohs defect area and depth, and canalicular involvement. Results: A total of 20 tunneled flaps were performed after successful Mohs excision of cutaneous malignancies. The average Mohs defect surface area was 13.57 cm2 with depth down to periosteum (n = 13), bone (n = 5), or orbital fat (n = 2). Five patients had full-thickness eyelid defects (25%), and nine (45%) had canalicular defects. The overall complication rate for this study was low with no flap failure. Two patients (10%) desired thinning of the subcutaneous flap for improved cosmesis, and one patient (5%) required further eyelid revision due to the complexity of the initial Mohs defect. The remaining 17 patients required no further surgical procedures. Conclusion: The tunneled paramedian forehead flap is a useful technique for medial canthal and eyelid reconstruction. This technique allows reconstruction of a challenging area. Complication rates are low, and this tunneled variation provides a single stage variation to the traditional multistage forehead pedicle flap.
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Leivo T, Sarmela J, Enckell-Aaltonen M, Dafgård Kopp E, Schmitt C, Toft PB, Sigurdsson H, Uusitalo M. Nordic treatment practices survey and consensus for treatment of eyelid sebaceous carcinoma. BMC Ophthalmol 2020; 20:103. [PMID: 32178641 PMCID: PMC7074984 DOI: 10.1186/s12886-020-01367-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 03/04/2020] [Indexed: 12/03/2022] Open
Abstract
Background The purpose was to describe the Nordic treatment practices and to reach a Nordic consensus for the treatment of sebaceous eyelid carcinoma. Methods The treatment practices data was collected by a questionnaire with 37 questions to the Nordic oculoplastic surgeons and analyzed. A PubMed MEDLINE database search was done to gather data on the published treatment practices and recommendations. A working group that consisted of in minimum one senior consultant from each leading Nordic University Eye Hospital was assigned. A structured interactive method was used to establish the consensus. Results Twenty-four doctors responded to the questionnaire. 23/24 (96%) of the respondents took a biopsy before surgery. Regional lymph node scanning was routinely done by 14/23 (61%) and a systemic screening of a metastatic disease by 13/23 (57%). 6/22 (27%) never took conjunctival mapping biopsies and 12/23 (52%) never screened for Muir- Torre. Respondents used Mohs surgery, frozen section or multi-stage excision with delayed closure, and 5–6 mm was the mostly preferred margin. Sentinel lymph node biopsy was a possible option for 9/22 (41%) and cryotherapy and Mitomycin C for 6/22 (27%) respondents. 50% of respondents considered radiation as a treatment option. 15/16 (94%) respondents always followed-up their patients, most for 5 years. Two thirds scanned regional lymph nodes during the follow-up. Consensus was reached for 18 statements representing three domains: preoperative work-up, treatment and follow-up. Conclusion Treatment practices differ in between the five Nordic countries which have similar public health care systems. In the article the authors present a Nordic consensus for the treatment of eyelid sebaceous carcinoma.
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Affiliation(s)
- Tiina Leivo
- Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, PO Box 220, FI-00029 HUS, Helsinki, Finland.
| | - Johanna Sarmela
- Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, PO Box 220, FI-00029 HUS, Helsinki, Finland
| | - Maria Enckell-Aaltonen
- Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, PO Box 220, FI-00029 HUS, Helsinki, Finland
| | - Eva Dafgård Kopp
- Department of Ophthalmology, S:t Erik's Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Caroline Schmitt
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Peter B Toft
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Haraldur Sigurdsson
- Department of Ophthalmology, Landspitali, University of Iceland, Reykjavik, Iceland
| | - Marita Uusitalo
- Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, PO Box 220, FI-00029 HUS, Helsinki, Finland
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Small margin (up to 2 mm) excision of periocular basal cell carcinomas in the setting of a one-stop clinic - long-term outcomes at a minimum of 11 years' follow-up. Eye (Lond) 2020; 34:2036-2040. [PMID: 31965082 DOI: 10.1038/s41433-020-0768-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 11/12/2019] [Accepted: 11/23/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To analyse the long-term outcome of small margin (up to 2 mm) excision of clinically well-demarcated primary periocular basal cell carcinomas (BCCs). METHODS Retrospective evaluation of 185 patients with excised well-demarcated primary BCCs at a minimum of 11 years following excision. All patients underwent tumour excision with maximum margins of 2 mm. Resulting defects were, if possible, closed directly. Reconstruction requiring flaps or grafts was delayed until receipt of the histological report, which was obtained in all cases. RESULTS Of 185 patients evaluated, 69 (37.3%) were still alive at the time of the study, at least 11 years post excision. One-stage excision and direct closure was performed in 60/69 patients (86.96%). In 9/69 patients (13.04%), excision was undertaken with reconstruction 4 days later, after receipt of the histopathology report. Histological assessment confirmed complete initial excision in 59/69 patients (85.5%) rising to 68 (98.6%) after two excisions. Mean follow-up was 13 years, with no recurrence in the living cohort. Three deceased patients had a recurrence, one of whose tumour was reported histologically as incompletely excised but declined further surgery, giving an overall recurrence rate of 3/185 (1.62%). For patients who completed treatment, the recurrence rate was 2 in 184 (1.09%). Six of the sixty-nine patients (8.7%) developed new tumours on the contralateral eyelid or the forehead. CONCLUSIONS Primary, clinically well-demarcated periocular BCCs can be safely treated using small (up to 2 mm) excision margins in a one-stop setting with immediate reconstruction for those defects which can be closed directly without recourse to flaps or grafts. SYNOPSIS A retrospective study of 185 patients who had small margin (≤2 mm) excision of clinically well-demarcated primary periocular BCCs demonstrated a recurrence rate of 3/185 (1.62%) at a minimum of 11 years' follow-up.
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Rougier G, Meningaud JP, Ganry L, Hermeziu O, Bosc R, Sidahmed-Mezi M, Hersant B. Oncological and aesthetic outcome following surgical management of orbito-palpebral skin cancers: A retrospective study of 132 patients. J Craniomaxillofac Surg 2019; 47:1577-1582. [DOI: 10.1016/j.jcms.2019.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/17/2019] [Accepted: 07/14/2019] [Indexed: 01/27/2023] Open
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