Two cases of periocular cutaneous angiosarcoma

The Eyelid Angiosarcoma: A Systematic Review of Characteristics and Clinical Course

A systematic search for eyelid angiosarcoma was performed from inception to December 2020 in Medline, EMBASE, and the Cochrane databases. Forty two eyelid angiosarcoma cases in 32 articles were analyzed. Eyelid angiosarcomas showed an incidence peak in the eighth decade of life, and was reported more frequently in Caucasian males. Eyelid angiosarcomas were associated with a mortality rate of 26.2%, a recurrence rate of 14.3%, and a cure rate of 45.2%. Four years event-free survival (EFS) rate was 36.0%, with median EFS of 36 months. Eyelid angiosarcomas with bilateral involvement or metastasis showed higher mortality and recurrence rates than unilateral eyelid invasion cases. In the prognosis analysis according to treatment modalities, the mortality and recurrence rates were the lowest in patients who underwent surgical excision. The 4-year EFS probability in a group with surgical excision was 60.6%, but in a group without surgical excision it was 30.3%. A total of 45.2% of the cases was misdiagnosed and 21.4% of the cases could not be correctly diagnosed with the first biopsy trial. The prognosis for eyelid angiosarcomas was better than that of angiosarcomas invading the face and scalp. Surgical excision was the most important treatment modality; thus, should be considered as the first treatment of choice.

Rapidly Progressive Periorbital Oedema: A Case of Cutaneous Angiosarcoma

Angiosarcoma is a rare form of malignant endothelial cell tumour characterised by rapidly infiltrating anaplastic cells of vascular or lymphatic origin. We report an uncommon case of cutaneous angiosarcoma (cAS) manifesting as rapidly progressive unilateral periorbital oedema. Due to the acute onset of disease, the patient was initially treated with antibiotics for presumed periorbital cellulitis. The lack of response to conservative management raised the suspicion of a more serious condition, which eventually revealed the diagnosis of angiosarcoma through skin biopsy. As suggested by several previous case reports, the subtle manifestation of cAS made it a great mimicker of benign skin conditions. This case report serves as a reminder to the aggressive nature of angiosarcoma which can lead to marked facial swelling within several weeks. As the tumour was not resectable by the time of diagnosis, the patient was offered palliative radiotherapy.

Adult Primary Capillary Hemangioma of the Sclera: A Previously Undescribed Entity With a Review of Epibulbar Vascular Lesions

PURPOSE

The objective of this article is to document a unique case of a primary hemangioma and review epibulbar vascular tumors of the conjunctiva and episclera.

METHODS

A case report with detailed histopathologic, histochemical, and immunohistochemical studies coupled with a comprehensive review of the relevant literature with a tabulation of previously reported epibulbar vascular lesions was performed.

RESULTS

A vascular tumor developed in a 46-year-old woman over 2-3 months that histopathologically was located in the superficial third of the normally avascular sclera and was composed of capillary caliber vessels. CD31 and CD34 positivity established the vascular nature of the lesion. Despite its adult onset, the tumor was also glut-1 positive, a vascular characteristic of childhood capillary hemangiomas that will ultimately involute. Smooth muscle actin was positive in the endothelial cells and associated pericytes. An ectatic muscular vessel identified in the midst of the lesion was interpreted as an anomalous intrascleral branch of an epibulbar anterior ciliary artery, where it perforated the sclera in the vicinity of the insertion of an extraocular rectus muscle. It was deduced to be the source of the capillary proliferation. A literature review failed to identify any previously reported epibulbar vascular tumor that originated primarily in the sclera or secondarily infiltrated this ocular tunic.

CONCLUSION

An adult primary capillary intrascleral neoplasm is described as the rarest of all epibulbar vascular tumors and in keeping with the exceptional status of the ocular endothelium was glut-1 positive. This lesion must be distinguished from an array of other common and esoteric epibulbar vascular conditions.

Periocular dermatoses

The periocular area may be affected by infectious or noninfectious diseases such as inflammatory dermatoses, systemic disease, drug reactions, benign and malignant lesions, traumatic lesions, and esthetic complications. We present a review of the most common periocular dermatoses.

A Recurrent Angiosarcoma Isolated to the Eyelid without the Recurrence on the Primary Lesion of the Forehead

Angiosarcoma is a highly malignant vascular tumor of endothelial origin. Initially, a cutaneous manifestation presents as a singular or multifocal bruise-like patches on the skin, most frequently on the face, the scalp or the neck regions. On progression, the lesions become violaceous, and ill-defined spongy nodular tumors appear. Our patient was a 71-year-old man with a previous history of angiosarcoma on the right forehead and was treated with an excision and local radiation 3 years ago. Several months after the treatment, a dark brownish to violaceous patch with edema arose from the right upper eyelid and spread out to the lower eyelid. Clinically, an ecchymosis caused by trauma or other hemangioma was suspected more than a recurrent angiosarcoma. Histopathologic examinations including immunohistochemical studies were consistent with cutaneous angiosarcoma. Herein, we report a rare case of a recurrent isolated angiosarcoma without the recurrence of a primary lesion.

Angiosarcoma presenting with minor erythema and swelling

A 76-year-old man presented with slowly progressive swelling in his forehead and left upper eyelid over the course of three months. CT scanning showed non-specific enhancement of subcutaneous tissues, suggesting a low-grade cellulitis. Poor response to treatment prompted an MRI, which revealed the presence of a soft tissue lesion. Biopsy of this lesion was positive for angiosarcoma. The patient underwent chemotherapy and radiation, but unfortunately succumbed to his malignancy eight months later. This case illustrates a rare example of facial/periorbital angiosarcoma, a benign-appearing but aggressive tumor associated with a high incidence of mortality. A review of the literature and current treatment options are discussed.

Mohs micrographic surgery of the eyelid: an overview of anatomy, pathophysiology, and reconstruction options

BACKGROUND

Mohs micrographic surgery (MMS) is the ideal treatment for skin cancer removal. The advantages of MMS in the eyelid area include its high cure rate, tissue-sparing effects, and overall cost effectiveness.

OBJECTIVE

To review eyelid anatomy, detail ocular tumors that are amenable to MMS, and examine the surgical repair options commonly used in this area.

MATERIALS AND METHODS

A review of the literature on MMS of the eyelid was performed with specific reference to ocular anatomy, eyelid malignancy types, and surgical reconstruction.

CONCLUSION

Eyelid function is critical for the maintenance of ocular health and vision. MMS is an ideal skin cancer treatment for the delicate structure of the eyelid, where maximal tissue preservation is critical. There are a plethora of reconstruction options to consider after MMS has been performed in this area. The choice of repair and surgical outcome depend, in part, on the surgeon's knowledge of eyelid anatomy and his or her ability to assess the repair requirements of the post-MMS defect. Dermatologic surgeons can effectively work with other specialists to help ensure that their patients receive a cure with restored ocular function and optimal cosmesis.

Periocular cutaneous malignancies: a review of the literature

BACKGROUND

The periocular skin is susceptible to numerous benign and malignant neoplasms. Periocular malignancies may present differently, behave more aggressively, and pose greater challenges for treatment and repair than malignancies at other cutaneous sites. Between 5% and 10% of cutaneous malignancies occur periorbitally, with basal cell carcinoma reported as the most common malignant periocular tumor, followed by squamous cell carcinoma, sebaceous gland carcinoma, cutaneous melanoma, Merkel cell carcinoma, and other rare tumors.

OBJECTIVE

To review the current literature on cutaneous malignancies of the periocular region pertaining to etiology, incidence, clinical presentation, differential diagnosis, complications, and treatment options.

MATERIALS AND METHODS

An extensive literature review was conducted using PubMed, searching for articles on periocular and periorbital cutaneous malignancies.

CONCLUSIONS

Timely diagnosis and management of periocular malignancies is essential because of their proximity to and potential to invade vital structures such as the orbit, sinuses, and brain. Surgical excision remains the standard of care for the majority of periorbital malignancies, but given the sensitive anatomic location, tissue-sparing techniques with margin control such as Mohs micrographic surgery are the preferred method for most nonmelanoma skin cancers. Depending on tumor type, other treatment modalities may include radiation, chemotherapy, cryosurgery, topical medications, and photodynamic therapy.