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Lee Boniao E, Allen RC, Sundar G. Targeted therapy and immunotherapy for orbital and periorbital tumors: a major review. Orbit 2024; 43:656-673. [PMID: 37728602 DOI: 10.1080/01676830.2023.2256848] [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: 03/26/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023]
Abstract
Traditionally, for patients who are poor candidates for surgery and/or radiotherapy, palliative chemotherapy is often offered but with significant toxic side effects. However, recent advancements in our understanding of tumor biology and molecular genetics have brought new understanding to the molecular pathways of certain tumors and cancers. This has ushered in a new era of precision medicine specific to a tumor or cancer treatment pathway (targeted therapy) or directed to host-tumor responses (immunotherapy). This article will focus on recent updates in the application of available targeted and immunotherapy for managing orbital and periorbital tumors and tumor-like conditions, which include cutaneous basal cell carcinoma, cutaneous squamous cell carcinoma, cutaneous melanoma, Merkel cell carcinoma, sebaceous gland carcinoma, solitary fibrous tumor, dermatofibrosarcoma protuberans, orbital meningioma, neurofibromatosis, Langerhans cell histiocytosis, ocular adnexal lymphoma, orbital lymphatic malformation, and adenoid cystic carcinoma.
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Affiliation(s)
- Emmanuel Lee Boniao
- Orbit & Oculofacial Surgery, Ophthalmic Oncology, Department of Ophthalmology, National University Hospital, National University of Singapore, Singapore, Singapore
- Department of Ophthalmology, Amai Pakpak Medical Center, Marawi City, Philippines
| | - Richard C Allen
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Gangadhara Sundar
- Orbit & Oculofacial Surgery, Ophthalmic Oncology, Department of Ophthalmology, National University Hospital, National University of Singapore, Singapore, Singapore
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Kayıkcı G, Topçu H, Cetin Efe A, Poslu Karademir F, Ulas MG. Association of benign and malignant neoplastic lesions of the eyelid with systemic inflammatory markers. Clin Exp Optom 2024:1-5. [PMID: 39250891 DOI: 10.1080/08164622.2024.2399774] [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: 04/09/2024] [Revised: 08/05/2024] [Accepted: 08/23/2024] [Indexed: 09/11/2024] Open
Abstract
CLINICAL RELEVANCE The role and prognostic significance of systemic inflammatory markers in various malignancies have been the subject of investigation. The role of these inflammatory markers in eyelid lesions remains to be elucidated. BACKGROUND Benign and malignant lesions of the eyelid are common presentations in eye clinics. Systemic inflammatory markers derived from a complete blood count may provide insight into the benign-malignant differentiation of the lesion. METHODS This study included 134 patients who underwent surgery for eyelid lesions between 2021-2023. The lesions were evaluated by oculoplastic surgeons and operated on with a preliminary diagnosis of benign or malignant. According to the histopathological diagnosis, benign lesions were included in Group 1 and malignant lesions in Group 2. The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and systemic immune inflammation index (SII) (NxP/L) based on neutrophil, lymphocyte, and platelet counts were calculated from the preoperative complete blood count of all patients. RESULTS Eighty-eight patients were included in Group 1 and 46 patients in Group 2. There were 41/47 (Female/Male) in Group 1 and 19/27 (F/M) males in Group 2 (p = 0.345). The mean age was 62.91 ± 9.04 years in Group 1 and 65.41 ± 8.76 years in Group 2 (p = 0.127). The preliminary diagnosis and histopathological diagnosis were incompatible in 5 cases in both groups. In Group 1: NLR = 1.82 ± 0.72, PLR = 124.50 ± 45.19 and SII = 454.51 ± 220.20, in Group 2: NLR = 2.48 ± 0.89, PLR = 128.12 ± 49.58 and SII = 590.22 ± 271.09. NLR and SII differences between groups were statistically significant, while PLR was similar (p < 0.001, p = .002, p = .671). ROC curve analysis showed that the optimal cut-off values for NLR, PLR, and SII were 1.99, 119.16, and 475.21, respectively. CONCLUSION High levels of NLR and SII in eyelid tumours can be used as an adjunct to examination findings in the preliminary diagnosis of the lesion as benign or malignant and may influence surgical planning.
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Affiliation(s)
- Gulce Kayıkcı
- Department of Ophthalmology, University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Husna Topçu
- Department of Ophthalmology, Osmangazi Aritmi Hospital, Bursa, Turkey
| | - Ayse Cetin Efe
- Department of Ophthalmology, University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Fatma Poslu Karademir
- Department of Ophthalmology, University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Goksel Ulas
- Department of Ophthalmology, University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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Nudelman NT, Ekhator N, Rothschild M, Wladis EJ. A SEER program study of survival trends in Merkel cell carcinoma of the eyelid: 2000-2019. Orbit 2024; 43:290-295. [PMID: 38032687 DOI: 10.1080/01676830.2023.2286380] [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: 08/18/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE Merkel cell carcinoma of the eyelid (MCCE) is a rare yet aggressive neuroendocrine tumour associated with significant morbidity and mortality. This study aimed to investigate survival trends and demographic factors related to MCCE, 2000-2019, using the Surveillance, Epidemiology, and End Results (SEER) Program. METHODS Cases were analysed by demographic parameters, disease properties, and survival. Statistical analyses were performed via a dedicated computerized software package. RESULTS A total 349 cases of MCCE were identified, accounting for 2% of all MCC cases in the United States during that time. Of note, the incidence of MCCE remained stable over the study period (p = .35). Female patients accounted for 56% of the cases, and males for 44%. White patients accounted for 90.8% of the the cases, and Black patients for 2.9%. MCCE incidence increased with age, with the majority of patients age 85+ (p < .05). Incidence was greatest in metropolitan areas and among those with median incomes >$75,000/year. Income correlated with likelihood of MCCE diagnosis (p < .05). Analysis of 5-year survival data showed 20% of the patients died due to MCCE within 5 years of diagnosis. Of these, the majority died within one year of diagnosis. CONCLUSIONS Consistent with previous reports, most patients were white, female, and age 85+.Incidence correlated with metropolitan environments and median income. While most patients did not die from MCCE, majority of recorded deaths occurred within one year of diagnosis.
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Affiliation(s)
- Nicole T Nudelman
- Department of Ophthalmology, Albany Medical College, Albany, New York, USA
| | - Nehikhare Ekhator
- Department of Ophthalmology, Albany Medical College, Albany, New York, USA
| | - Michael Rothschild
- Department of Ophthalmology, Albany Medical College, Albany, New York, USA
| | - Edward J Wladis
- Department of Ophthalmology, Albany Medical College, Albany, New York, USA
- Department of Otolaryngology, Albany Medical College, Albany, New York, USA
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Peirano D, Vargas S, Hidalgo L, Donoso F, Abusleme E, Sanhueza F, Cárdenas C, Droppelmann K, Castro JC, Uribe P, Zoroquiain P, Navarrete-Dechent C. Management of periocular keratinocyte carcinomas with Mohs micrographic surgery and predictors of complex reconstruction: a retrospective study. An Bras Dermatol 2024; 99:202-209. [PMID: 37989688 PMCID: PMC10943309 DOI: 10.1016/j.abd.2023.05.004] [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: 03/14/2023] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Skin cancer is the most frequent cancer worldwide and the most frequent periocular tumor. Keratinocyte Carcinomas (KC) located in periorificial areas, such as periocular tumors, are considered high-risk tumors. Mohs Micrographic Surgery (MMS) is considered the first line for the treatment of high-risk KC, providing a lower recurrence rate than conventional wide excision. OBJECTIVE To describe the clinical-pathological features of periocular KC treated with MMS in a tertiary university center in Chile. METHODS A single-center, retrospective study of patients with KC located on the periocular area, that underwent MMS between 2017‒2022. MMS details were recorded. RESULTS One hundred thirteen patients with periocular carcinomas were included. The mean age was 59 ± 13 years; 52% were women. The most frequent location was the medial canthus (53%), followed by the lower eyelid (30.1%). The most frequent BCC histology was the nodular variant (59.3%). Regarding MMS, the average number of stages was 1.5 ± 0.7, and 54% of the cases required only 1 stage to achieve clear margins. To date, no recurrence has been reported. Tumors larger than 8.5 mm in largest diameter or 43.5 mm2 were more likely to require complex reconstruction. STUDY LIMITATIONS Retrospective design and a relatively low number of patients in the SCC group. Possible selection bias, as larger or more complex cases, may have been referred to oculoplastic surgeons directly. CONCLUSION The present study confirms the role of MMS for the treatment of periocular KCs. Periocular KCs larger than 8.5 mm might require complex reconstruction. These results can be used to counsel patients during pre-surgical visits.
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Affiliation(s)
- Dominga Peirano
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastián Vargas
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Leonel Hidalgo
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisca Donoso
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eugenia Abusleme
- Department of Ophtalmology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Sanhueza
- Department of Ophtalmology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Consuelo Cárdenas
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Katherine Droppelmann
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Camilo Castro
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Uribe
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Zoroquiain
- Department of Pathology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristian Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Gąsiorowski K, Gontarz M, Marecik T, Szczurowski P, Bargiel J, Zapała J, Wyszyńska-Pawelec G. Risk Factors for Orbital Invasion in Malignant Eyelid Tumors, Is Orbital Exenteration Still Necessary? J Clin Med 2024; 13:726. [PMID: 38337420 PMCID: PMC10856173 DOI: 10.3390/jcm13030726] [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: 10/27/2023] [Revised: 01/13/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
Basal cell carcinoma is the most common malignant skin tumor of the eyelids in Caucasians, followed by squamous cell carcinoma and sebaceous gland carcinoma. The primary treatment for these tumors is radical excision. In cases where malignant eyelid tumors are advanced and have invaded the orbit, orbital exenteration is necessary. In this retrospective study, we aimed to determine the correlation between the risk of orbital infiltration and various factors like tumor location, size, histological type, and patient age. This study revealed that tumors in multiple regions increased the risk of orbital infiltration by 3.75 times. Tumors with a diameter of 21-30 mm raised the likelihood of requiring exenteration by 15.5 times compared to smaller tumors (up to 10 mm). Age was also associated with the likelihood of orbital invasion in periocular tumors. Interestingly, no correlation was found between the histological type of the tumor and the risk of orbital infiltration. Notably, the conjunctiva of the eyeball was the most commonly infiltrated orbital structure, followed by the orbital fat. Timely treatment and well-planned procedures are crucial for patients with malignant periocular skin tumors to avoid multiple reoperations and the potential need for orbital exenteration.
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Affiliation(s)
- Krzysztof Gąsiorowski
- Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, 30-688 Cracow, Poland; (M.G.); (T.M.); (P.S.); (J.B.); (J.Z.); (G.W.-P.)
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Hooper J, Shao K, Feng PW, Falcone M, Feng H. Periocular and ocular surface nonmelanoma skin cancer. Clin Dermatol 2024; 42:71-77. [PMID: 37866412 DOI: 10.1016/j.clindermatol.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Periocular and ocular surface nonmelanoma malignancies, including basal cell carcinoma (BCC), squamous cell carcinomas (SCC), and ocular surface squamous neoplasia (OSSN), are rare, but their management requires special considerations. The most common periocular malignancy is BCC, which constitutes 80% to 96% of tumors, followed by SCC, which represents 5% to 10% of tumors. OSSN represents a spectrum of diseases that encompass dysplastic alteration to the squamous epithelium of the eye. OSSN ranges from squamous dysplasia to conjunctival intraepithelial neoplasia/carcinoma in situ to invasive SCC, which is the most common ocular malignancy. These tumors can be staged using the eighth edition of the American Joint Committee on Cancer categorization system. The standard of care for periocular malignancies is Mohs micrographic surgery, while medical management with 5-fluorouracil (5-FU), interferon alfa-2b (INF), and mitomycin C (MMC) or "no touch" surgical excision are options for OSSN. Systemic therapies, including sonic hedgehog inhibitors for BCC and epidermal growth factor inhibitors and immune-checkpoint inhibitors for SCC, can be utilized for advanced disease. Recurrence rates are higher for periorbital and ocular malignancies than their respective cutaneous counterparts. These carcinomas and their respective treatments have unique side effects and considerations in an effort to preserve visual function.
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Affiliation(s)
- Jette Hooper
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Kimberly Shao
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Paula W Feng
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Madina Falcone
- Department of Surgery, Division of Ophthalmology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA.
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Agarwal A, Philips R, Landers K, Savitch S, Barbarite E, Krein H, Heffelfinger R. Functional and Symmetry Outcomes After Forehead Flap Reconstruction of Medial Peri-Ocular Defects. Laryngoscope 2023; 133:2584-2589. [PMID: 36644993 DOI: 10.1002/lary.30566] [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: 09/28/2022] [Revised: 12/19/2022] [Accepted: 12/29/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Orbital defects have a profound impact on orbital function and symmetry of the face and are difficult to reconstruct given the complexity of this area. The paramedian forehead flap (PMFF) has not been well studied in reconstruction of orbital defects. METHODS Retrospective review of patients who underwent reconstruction of periorbital defects with PMFF between 2016 and 2021. Variables were ocular adnexal asymmetry, functional outcomes, and orbital complications. RESULTS Eighteen patients met inclusion criteria. Mean defect size was 11.1 ± 7.5 cm. The most common subsite involved was medial canthus in 88.9% of patients. There was no statistically significant difference between mean medial canthus to midline ratio and mean medial brow to midline ratio when compared to the assumed normal of 1. The medial canthus to pupil ratio and medial canthus to lateral canthus ratio had a statistically significant mean difference from 1.0 (p = 0.003 for both). In 22.2% of patients, the orbit was functional with impairment; the remaining had no impairment. Surgical sequelae occurred in 12/18 (66.7%) of patients, most commonly epiphora in 9/18 (50%) of patients, and ectropion in 5/18 (27.7%). CONCLUSION The PMFF is feasible for medial periorbital reconstruction with acceptable functional and symmetrical outcomes and low morbidity. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2584-2589, 2023.
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Affiliation(s)
- Aarti Agarwal
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ramez Philips
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kathryn Landers
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology - Head and Neck Surgery, Rush University, Chicago, Illinois, USA
| | - Samantha Savitch
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric Barbarite
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Howard Krein
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ryan Heffelfinger
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Fan W, Rokohl AC, Kupka P, Hou X, Liu J, Li S, Kopecky A, Ju S, Matos PAW, Guo Y, Heindl LM. Reproducibility of Three-Dimensional Volumetric Measurement of Periocular Tumor Models. Ophthalmol Ther 2023; 12:111-123. [PMID: 36245061 PMCID: PMC9834469 DOI: 10.1007/s40123-022-00595-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/06/2022] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION In this study, we measured the volume of customized tumor models in the periocular area using three-dimensional (3D) stereophotogrammetry and evaluated the reproducibility of these measurements. METHODS Five tumor models of different colors and sizes were placed in different periocular positions, and 3D facial images were obtained from 68 healthy adult volunteers. Subsequently, the volumes of the tumor models were measured, and the intra- and interrater reproducibility was assessed. RESULTS The gray 6 mm model revealed the highest reliable measurements in both Caucasians (intra- and interrater intraclass correlation coefficients of 0.981 and 0.899, mean absolute difference of 1.446 and 3.327 mm3, relative error measurement of 3.497% and 8.120%, technical error of measurement of 1.450 and 3.105 mm3, and relative technical error of measurement of 3.506% and 7.580%) and Asians (0.968 and 0.844, 1.974 and 4.067 mm3, 4.772% and 9.526%, 2.100 and 4.302 mm3, and 5.076% and 10.076%, respectively). The highest reliability of measurements in the lateral upper eyelid (0.88 and 0.95, 4.042 and 3.626 mm3, 9.730% and 9.020%, 5.714 and 3.358 mm3, and 9.730% and 8.350%, respectively) and medial upper eyelid (0.81 and 0.89, 4.313 and 4.226 mm3, 9.730% and 9.020%, 6.098 and 4.069 mm3, and 9.730% and 8.350%, respectively) with eyes closed was evident in Caucasians, while the same trend (0.841 and 0.815, 2.828 and 3.757 mm3, 9.860% and 9.840%, 4.052 and 4.308 mm3, and 9.860% and 9.740%, respectively) was observed in Asians in the medial canthus with eyes closed. CONCLUSIONS This study confirms, for the first time, the high reliability of periocular tumor volume measurements using 3D stereophotogrammetry, suggesting its feasibility for eyelid tumor measurement. Further trials are required to investigate its clinical use for documentation and follow-up of different eyelid tumors.
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Affiliation(s)
- Wanlin Fan
- grid.6190.e0000 0000 8580 3777Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Alexander C. Rokohl
- grid.6190.e0000 0000 8580 3777Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany ,Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Dusseldorf, Cologne, Germany
| | - Patrick Kupka
- grid.6190.e0000 0000 8580 3777Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Xiaoyi Hou
- grid.6190.e0000 0000 8580 3777Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Jinhua Liu
- grid.6190.e0000 0000 8580 3777Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Senmao Li
- grid.6190.e0000 0000 8580 3777Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Adam Kopecky
- grid.412727.50000 0004 0609 0692Ophthalmology Clinic, University Hospital Ostrava, Ostrava, Czech Republic
| | - Sitong Ju
- grid.6190.e0000 0000 8580 3777Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Philomena A. Wawer Matos
- grid.6190.e0000 0000 8580 3777Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Yongwei Guo
- grid.13402.340000 0004 1759 700XEye Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009 China ,grid.13402.340000 0004 1759 700XZhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Ludwig M. Heindl
- grid.6190.e0000 0000 8580 3777Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany ,Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Dusseldorf, Cologne, Germany
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Huang X, Yao C, Xu F, Chen L, Wang H, Chen X, Ye J, Wang Y. MAC-ResNet: Knowledge Distillation Based Lightweight Multiscale-Attention-Crop-ResNet for Eyelid Tumors Detection and Classification. J Pers Med 2022; 13:jpm13010089. [PMID: 36675750 PMCID: PMC9863962 DOI: 10.3390/jpm13010089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022] Open
Abstract
Eyelid tumors are tumors that occur in the eye and its appendages, affecting vision and appearance, causing blindness and disability, and some having a high lethality rate. Pathological images of eyelid tumors are characterized by large pixels, multiple scales, and similar features. Solving the problem of difficult and time-consuming fine-grained classification of pathological images is important to improve the efficiency and quality of pathological diagnosis. The morphology of Basal Cell Carcinoma (BCC), Meibomian Gland Carcinoma (MGC), and Cutaneous Melanoma (CM) in eyelid tumors are very similar, and it is easy to be misdiagnosed among each category. In addition, the diseased area, which is decisive for the diagnosis of the disease, usually occupies only a relatively minor portion of the entire pathology section, and screening the area of interest is a tedious and time-consuming task. In this paper, deep learning techniques to investigate the pathological images of eyelid tumors. Inspired by the knowledge distillation process, we propose the Multiscale-Attention-Crop-ResNet (MAC-ResNet) network model to achieve the automatic classification of three malignant tumors and the automatic localization of whole slide imaging (WSI) lesion regions using U-Net. The final accuracy rates of the three classification problems of eyelid tumors on MAC-ResNet were 96.8%, 94.6%, and 90.8%, respectively.
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Affiliation(s)
- Xingru Huang
- College of Media Engineering, Communication University of Zhejiang, Hangzhou 310042, China
- School of Electronic Engineering and Computer Science, Queen Mary University of London, Mile End Road, London E1 4NS, UK
| | - Chunlei Yao
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Feng Xu
- School of Computer Science and Technology, Hangzhou Dianzi University, Hangzhou 310005, China
| | - Lingxiao Chen
- School of Computer Science and Technology, Hangzhou Dianzi University, Hangzhou 310005, China
| | - Huaqiong Wang
- College of Media Engineering, Communication University of Zhejiang, Hangzhou 310042, China
| | - Xiaodiao Chen
- College of Media Engineering, Communication University of Zhejiang, Hangzhou 310042, China
- School of Computer Science and Technology, Hangzhou Dianzi University, Hangzhou 310005, China
| | - Juan Ye
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Yaqi Wang
- College of Media Engineering, Communication University of Zhejiang, Hangzhou 310042, China
- Correspondence:
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Ramachandran V, Phan K. Mohs micrographic surgery versus wide local excision for eyelid melanoma: An analysis of a national database. J Plast Reconstr Aesthet Surg 2022; 75:4410-4415. [PMID: 36257889 DOI: 10.1016/j.bjps.2022.08.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 06/18/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although eyelid melanomas represent less than 1% of eyelid neoplasms, they have the worst prognosis. Wide local excision (WLE) and Mohs micrographic surgery (MMS) are mainstay treatment options. We conducted a retrospective analysis to assess all-cause and cause-specific mortality rates in patients undergoing WLE or MMS for eyelid melanoma. METHODS A retrospective analysis of Surveillance, Epidemiology, and End Results (SEER) registry was performed for eyelid melanoma treated with WLE or MMS. Cases were limited to American Joint Committee on Cancer (AJCC) stage T1 primary malignancies. RESULTS A total of 45 cases of WLE were identified along with 48 cases of MMS for eyelid melanoma. There was no significant difference between subgroups in age group, sex, race, ethnicity, marital status at diagnosis, AJCC N stage, AJCC M stage, melanoma histology, chemotherapy use, and radiotherapy use. Among the cohort, all tumors were unilateral. Kaplan-Meier analysis with log-rank demonstrated no significant difference between MMS and WLE subgroups with regard to overall survival (P = 0.662) and cancer-specific survival (P = 0.494). Cox regression adjusting for variables with α<0.10 and found no significant difference in all-cause mortality (HR, 0.923; 95% CI 0.310-2.747; P = 0.885) or cancer-specific mortality (HR, 0.518; 95% CI 0.047-5.711; P = 0.591) when patients who underwent MMS were compared to those who underwent WLE. CONCLUSION While our study is limited by a small number of patients, our analysis demonstrated no significant difference in all-cause or cause-specific survival for patients with eyelid melanoma treated with MMS compared with WLE. In areas requiring preservation of tissue due to cosmetic or functional purposes, MMS is a reasonable surgical approach.
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Affiliation(s)
| | - Kevin Phan
- Department of Dermatology, Liverpool Hospital, Liverpool, Sydney, Australia; South Western Sydney Clinical School, University of New South Wales (UNSW), Liverpool, Sydney, Australia
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11
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Patient Impressions of Periorbital Skin Cancers. Dermatol Surg 2022; 48:889-890. [PMID: 35917270 DOI: 10.1097/dss.0000000000003486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Refined concept of motor supply to the medial periorbital area relevant to periorbital surgery. Plast Reconstr Surg 2022; 150:647-657. [PMID: 35791278 DOI: 10.1097/prs.0000000000009473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mimetic muscles in the medial periorbital area were thought to be innervated solely by the angular nerve. Recently however, the upper medial palpebral branch and lower palpebral branch were reported as additional motor suppliers in this area. This study aimed to define all the motor nerve systems passing through the medial canthal area. METHODS Motor nerve branches that passed through the medial canthal region were identified and traced thoroughly from the parotid gland to their destinations under a surgical microscopic field in 74 hemifaces. The courses, anatomical positions of, and anatomical relationships between the angular nerve and the upper medial palpebral branch were observed. RESULTS The upper medial palpebral branch and the angular nerve were found in all samples within a 3-6 mm area lateral to the intersecting point of the medial orbital rim and medial canthal ligament. The upper medial palpebral branch supplied the upper eyelid, whereas the angular nerve supplied the extra-orbicularis muscles in the medial periorbital area. The medial pretarsal area of the upper eyelid was supplied solely by the pretarsal branches of the upper medial palpebral branch, which was formed by uniting three or four minor branches that traveled throughout the anterior cheek. CONCLUSION wo separate motor nerve systems, the upper medial palpebral branch and the angular nerve, exist in the medial canthal area. The upper medial palpebral branch course along the medial orbital rim is considered as a facial nerve danger zone.
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13
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Eyelid malignancies in young individuals: clinical peculiarities. Int Ophthalmol 2022; 42:1867-1874. [PMID: 35088362 DOI: 10.1007/s10792-021-02184-3] [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: 08/05/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The incidence of malignant eyelid tumors is considerably increasing, even in young patients. The purpose of this study was to identify particularities in individuals under 40 years of age affected by eyelid malignancies. METHODS Clinical charts of patients under 40 years of age who underwent eyelid tumor excision from 2014 to 2020 in two reference centers, one in Brazil and one in the USA, were reviewed. Demographic and outcome measures included: age, gender, skin phototype, comorbidities, diagnosis, time until diagnosis, lesion location, recurrence and metastasis. In addition, associated characteristics, including chronic sun exposure, intentional tanning (outdoor or artificial), history of smoking, use of sunscreen, family history of skin cancer and exposure to pesticides or herbicides, were reviewed. RESULTS A total of 24 malignant eyelid tumors from 17 patients were identified. Twelve (70.6%) patients were female, and the most prevalent tumor was basal cell carcinoma (62.5%). Three (17.6%) patients had xeroderma pigmentosum and presented with multiple lesions. Family history of skin cancer was reported by 47% of patients. Prolonged sun exposure was reported by 41.2%; history of smoking and intentional tanning were reported by 23.5 and 17.6%, respectively, and might have played a role in carcinogenesis. CONCLUSIONS Although uncommon in young subjects, eyelid malignancies present some peculiarities in individuals under 40 years of age. Our results suggest that women with family history of skin cancer and history of chronic exposure to ultraviolet radiation are at risk. Association with genetic syndromes is also relevant among younger age groups.
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Dobbs NW, Budak MJ, White RD, Zealley IA. MR-Eye: High-Resolution Microscopy Coil MRI for the Assessment of the Orbit and Periorbital Structures, Part 2: Clinical Applications. AJNR Am J Neuroradiol 2021; 42:1184-1189. [PMID: 33737269 DOI: 10.3174/ajnr.a7080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/20/2020] [Indexed: 11/07/2022]
Abstract
In the first part of this 2-part series, we described how to implement microscopy coil MR imaging of the orbits. Beyond being a useful anatomic educational tool, microscopy coil MR imaging has valuable applications in clinical practice. By depicting deep tissue tumor extension, which cannot be evaluated clinically, ophthalmic surgeons can minimize the surgical field, preserve normal anatomy when possible, and maximize the accuracy of resection margins. Here we demonstrate common and uncommon pathologies that may be encountered in orbital microscopy coil MR imaging practice and discuss the imaging appearance, the underlying pathologic processes, and the clinical relevance of the microscopy coil MR imaging findings.
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Affiliation(s)
- N W Dobbs
- From the Department of Clinical Neuroscience (N.W.D.), Royal Hospital for Children and Young People, Edinburgh, UK
| | - M J Budak
- Qscan Radiology Clinics (M.J.B.), Brisbane, Queensland, Australia
| | - R D White
- Department of Clinical Radiology (R.D.W.), University Hospital of Wales, Cardiff, UK
| | - I A Zealley
- Department of Clinical Radiology (I.A.Z.), Ninewells Hospital, Dundee, UK
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Diaz Cespedes RA, Ortega Evangelio L, Oprisan A, Olate Perez A. Utility of the Glabellar Flap in the Reconstruction of Medial Canthal Tumors after Mohs Surgery. Turk J Ophthalmol 2021; 51:118-122. [PMID: 33951901 PMCID: PMC8109041 DOI: 10.4274/tjo.galenos.2020.04641] [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] [Indexed: 12/01/2022] Open
Abstract
The goals of periorbital region reconstruction are to obtain both functional and esthetic results. Medial canthus is the second most common periorbital location for basal cell carcinoma. If left untreated, it is locally destructive but rarely metastasizes. Incompletely resected medial canthal tumors recur or penetrate along the lacrimal path and expand to wider lesions. A safety margin is necessary to ensure a complete lesion resection. Since it was introduced in 1941, Mohs surgery has been promoted as an efficient method of dealing with infiltrative periorbital skin tumors. It has been shown to have high rates of complete cancer removal during surgery, minimizing the amount of normal tissue loss and securing better functional and cosmetic outcomes. Due to its concave contour and convergence of skin units with variable thickness, texture and mobility, reconstruction of the medial canthal region (MCR) remains challenging. Reconstructive methods such as free full-thickness skin grafts and glabellar flaps have been used alone or in combination with other techniques. The concavity of the canthus must be achieved, but the maintenance of the normal contour and symmetry of the surrounding tissue is critical. The glabellar flap (GF) is a triangular advancement flap that adequately restores the volume in deeper defects, guaranteeing sufficient vascular support without complex or undesirable scars. We present two cases of basal cell carcinoma affecting the MCR that was successfully reconstructed using a GF alone in one case and together with a cheek advancement flap in the second one. In both cases, tumor excision was performed using Mohs surgery.
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Affiliation(s)
| | | | - Anca Oprisan
- Universitary and Politechnic Hospital la Fe, Department of Radiology, Valencia, Spain
| | - Alvaro Olate Perez
- Clinic and Provincial Hospital of Barcelona, Department of Ophthalmology, Barcelona, Spain
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Epidemiological Profile and Clinical Stage at Presentation of Eyelid Malignancies in a Multi-Ethnic Country. J Craniofac Surg 2021; 32:e642-e645. [PMID: 33852518 DOI: 10.1097/scs.0000000000007649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Eyelid malignancies are frequently seen in clinical practice. There is a lack of studies that have assessed the features of these lesions in mixed population countries. The epidemiologic profile, clinical stage at presentation, management, and outcomes of patients with eyelid malignancies were assessed, in order to better understand the features of these lesions in a multi-ethnic country. The medical records of patients who underwent eyelid tumor excision in a tertiary service in Brazil, from 2014 to 2019 were retrospectively reviewed. It was recorded for each patient: age, gender, time of onset, location, diagnosis, management, and follow-up. The medical records of 298 patients who presented with eyelid tumors were evaluated and 67 (22.4%) were malignant. The mean age of patients with malignancies was 52.93 years and 50% were male. Basal cell carcinoma was the most prevalent (61.2%), followed by squamous cell carcinoma (SCC) (29.9%) and sebaceous gland carcinoma (3%). The average time it took from appearance to surgical treatment was 3 years; the lower eyelid was the most affected for both basal cell carcinoma and SCC; 70% of SCCs were locally invasive at presentation and metastasis occurred in 15%. Basal cell carcinoma was the most common eyelid malignancy observed, however, its frequency was lower when compared to other western countries. The advanced stage at presentation may reflect the lack of education of the population to seek early care, and the lack of specialized tertiary centers in remote areas, resulting in delayed diagnosis.
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Dahlstrand U, Sheikh R, Berggren J, Hult J, Albinsson J, Cinthio M, Malmsjö M. Spectral Signatures in the Different Layers of the Human Eyelid by Photoacoustic Imaging. Lasers Surg Med 2020; 52:341-346. [DOI: 10.1002/lsm.23148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Ulf Dahlstrand
- Department of Clinical Sciences Lund, Ophthalmology, Skåne University HospitalLund UniversityLund SE‐221 85 Sweden
| | - Rafi Sheikh
- Department of Clinical Sciences Lund, Ophthalmology, Skåne University HospitalLund UniversityLund SE‐221 85 Sweden
| | - Johanna Berggren
- Department of Clinical Sciences Lund, Ophthalmology, Skåne University HospitalLund UniversityLund SE‐221 85 Sweden
| | - Jenny Hult
- Department of Clinical Sciences Lund, Ophthalmology, Skåne University HospitalLund UniversityLund SE‐221 85 Sweden
| | - John Albinsson
- Department of Clinical Sciences Lund, Ophthalmology, Skåne University HospitalLund UniversityLund SE‐221 85 Sweden
| | - Magnus Cinthio
- Department of Biomedical Engineering, Faculty of EngineeringLund UniversityLund SE‐221 00 Sweden
| | - Malin Malmsjö
- Department of Clinical Sciences Lund, Ophthalmology, Skåne University HospitalLund UniversityLund SE‐221 85 Sweden
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Hamdoon Z, Jerjes W, Hopper C. Periorbital skin cancers subjected to mTHPC-photodynamic therapy: A prospective study. Skin Res Technol 2019; 26:338-342. [PMID: 31777106 DOI: 10.1111/srt.12806] [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: 09/08/2019] [Accepted: 11/09/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Photodynamic therapy (PDT) is a relatively new method of treating skin cancers. This prospective study highlights the use of PDT in the management of basal cell carcinomas (BCCs) and T1N0 cutaneous squamous cell carcinomas (SCCs) involving the periorbital area. MATERIALS AND METHODS Surface illumination PDT was offered under local anaesthesia. mTHPC was administered intravenously. A single-channel 652 nm diode laser was used for illumination, and light was delivered at 20 J/cm2 per site. Lesion response evaluation was carried out according to response evaluation criteria in solid tumours (RECIST). RESULTS After the first round of treatment, all cutaneous T1N0 SCC patients had complete response (CR) and continued to be in remission until last clinic review. For BCC patients, 12/14 patients had CR. The two remaining patients underwent a second round of treatment and also achieved a CR. All BCC patients were in remission at the last clinic review. Using visual analogue scale (VAS), 15 patients reported that this treatment gave them "excellent" cosmetic outcome (VAS 9-10). CONCLUSION Photodynamic therapy achieved high efficacy in the treatment of periorbital BCCs and cutaneous SCCs with greatly reduced morbidity and disfigurement.
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Affiliation(s)
- Zaid Hamdoon
- College of Dental Medicine, University of Sharjah, Sharjah, UAE.,Unit of OMFS, UCL Eastman Dental Institute, London, UK
| | - Waseem Jerjes
- University College London Medical School, London, UK.,North End Medical Centre, London, UK
| | - Colin Hopper
- Unit of OMFS, UCL Eastman Dental Institute, London, UK.,University College London Medical School, London, UK
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19
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Basal cell carcinomas of the eyelid: Results of an initial surgical management. J Fr Ophtalmol 2019; 42:1094-1099. [PMID: 31727330 DOI: 10.1016/j.jfo.2019.03.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/19/2019] [Accepted: 03/11/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE Our objective was to assess the results of surgical management of palpebral basal cell carcinomas (BCC) followed by a second line treatment discussed during a Multidisciplinary Team Meeting (MTM). MATERIALS AND METHODS This retrospective single-centred study includes all surgically-treated basal cell carcinomas of the eyelids between January 2005 and January 2015. After initial surgery, the cases were systematically discussed during a multidisciplinary team meeting in order to assess the need for additional treatment. Data relative to the patient, tumor and management were pulled from the medical record. RESULTS A total of 171 patients were included, with a mean age of 74 years. Among the patients, 151 underwent pentagonal resection of the tumor, and 20 patients had a superficial excision. After surgical management, 120 patients (70.2%) were considered to have sufficient free margins. The other 51 patients (29.8%) had insufficient margins due to remaining tumor cells (38 patients) or free margins less than 1mm. Among these 51 patients with insufficient margins, 19 received a second surgical treatment, 17 patients received adjuvant radiotherapy, and 15 were followed closely with an intensive biannual follow-up program. No patients were lost to follow-up. With a mean follow-up of 42 months (min. 6 months-max. 128 months), 7 out of 171 patients (4.1%) developed a local recurrence. The mean time between surgical management and recurrence was 24 months. The recurrence rate was higher for the group of patients with a recurrent tumor (11.6%) than for the group of patients referred for initial management (2.8%). Incomplete resection was also associated with a higher recurrence rate (3 recurrences out of 51 patients). DISCUSSION The management of basal cell carcinomas of the eyelid is first and foremost surgical with the goal of complete resection confirmed by histopathological analysis. The histological analyses (Mohs micrographic surgery, frozen section technic, paraffin fixation) and recommended sizes of the margins can vary in the literature, with recurrence rates from 1.8% to 9.5%. CONCLUSION In our experience, multidisciplinary management of BCC of the eyelid, including initial macroscopic surgery, histopathological analysis stating the histological type and size of the margins, along with additional treatment discussed in a MTM, allows for a recurrence rate of 4.1%.
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Lazarevic D, Ramelyte E, Dummer R, Imhof L. Radiotherapy in Periocular Cutaneous Malignancies: A Retrospective Study. Dermatology 2019; 235:234-239. [PMID: 30939473 DOI: 10.1159/000496539] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/27/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Due to the importance of function and cosmetics, periocular skin malignancies represent a therapeutic challenge. OBJECTIVE To evaluate the safety and efficacy of radiotherapy (RT) treating periocular skin tumors. METHODS Data of patients with periocular tumors treated with grenz or soft X-rays at the University Hospital Zurich, Switzerland, between 2009 and 2014 were reviewed. Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) with associated in situ lesions, cutaneous melanoma, lentigo maligna (LM), cutaneous lymphoma and Kaposi's sarcoma were included in the analysis. RESULTS We found 159 periocular lesions in 145 patients. Overall recurrence was highest for actinic keratosis and Bowen's disease (27%), melanoma (17%) and LM (15%), whereas SCC and BCC showed recurrence in 11 and 10%, respectively. 45% of all recurrences occurred within 12 months after treatment, with a median time to recurrence of 13 months (range 3-73). CONCLUSION RT, which provides a good therapeutic response with minimal adverse events, is a therapy option for periocular cutaneous malignancies.
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Affiliation(s)
- Diana Lazarevic
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Egle Ramelyte
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Laurence Imhof
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland,
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21
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Weesie F, Naus NC, Vasilic D, Hollestein LM, van den Bos RR, Wakkee M. Recurrence of periocular basal cell carcinoma and squamous cell carcinoma after Mohs micrographic surgery: a retrospective cohort study. Br J Dermatol 2019; 180:1176-1182. [PMID: 30536656 PMCID: PMC6849866 DOI: 10.1111/bjd.17516] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2018] [Indexed: 12/02/2022]
Abstract
Background Despite the widespread use of Mohs micrographic surgery (MMS) for periocular basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) – together called keratinocyte carcinoma (KC) – follow‐up data regarding recurrences are limited. Objectives To investigate the recurrence rate for periocular KCs after MMS and to describe our experience with interdisciplinary collaborations. Methods Patients with periocular KCs treated with MMS between 2006 and 2016 in a tertiary MMS referral hospital were included in this retrospective cohort study. Descriptive statistics were used to describe the MMS procedure‐related characteristics. Using follow‐up data from the electronic patient records and linkage with the Dutch nationwide network and registry of histopathology and cytopathology on 30 June 2017, the recurrence rate was evaluated and calculated using a cumulative incidence curve. Results In total, 683 (93·7%) periocular BCCs and 46 (6·3%) SCCs were treated with MMS. Three‐quarters (n = 549) were primary tumours and the majority were located at the medial canthus or lower eyelid (n = 649, 89·0%). In 505 MMS procedures (69·3%) an oculoplastic surgeon participated, and in 63 patients (8·6%) a plastic surgeon performed the reconstruction. After a median follow‐up of 46 months the recurrence rate was 3·0%, based on 22 recurrences (20 BCCs and two SCCs). Conclusions MMS is an excellent treatment option for periocular KCs, with a low recurrence rate. Due to this specific anatomical location an interdisciplinary approach should pre‐eminently be considered. What's already known about this topic? Mohs micrographic surgery (MMS) is a widespread treatment for periocular basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) because of the expected high cure rate, while preserving healthy tissue. Follow‐up data on the risk of recurrence after periocular MMS are limited.
What does this study add? This retrospective cohort study demonstrates that with a recurrence rate of 3·0% after almost 4 years, MMS has proven to be an excellent surgical treatment option for periocular BCC and SCC. We advise a low threshold for interdisciplinary collaborations, especially in case of recurrent BCCs, BCCs localized in the medial canthus and aggressive BCCs.
Linked Comment: https://doi.org/10.1111/bjd.17736. https://www.bjdonline.com/article/
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Affiliation(s)
- F Weesie
- Department of Dermatology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - N C Naus
- Department of Ophthalmology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - D Vasilic
- Department of Plastic Surgery, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - L M Hollestein
- Department of Dermatology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - R R van den Bos
- Department of Dermatology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - M Wakkee
- Department of Dermatology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
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23
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Xu Y, Li F, Jia R, Fan X. Updates on the clinical diagnosis and management of ocular sebaceous carcinoma: a brief review of the literature. Onco Targets Ther 2018; 11:3713-3720. [PMID: 29983580 PMCID: PMC6027821 DOI: 10.2147/ott.s162073] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Ocular sebaceous carcinoma (SC) is an exceedingly rare but aggressive malignancy that can impair patients’ visual acuity or even cause tumor-specific mortality. This tumor usually mimics chronic benign eyelid lesions, thus leading to delayed diagnosis, thereby causing high recurrence and metastasis. Ophthalmologists should be more aware of SC in order to offer correct diagnosis and treatment at the onset of symptoms. Prompt surgical excision with frozen section margin control is the mainstay of SC management after patient evaluation and accurate biopsy. Mohs micrographic surgery has been associated with better tumor control outcomes than wide local excision. Radiation therapy should be considered as adjuvant treatment for locally advanced (stage T3a or higher) or high-risk (pagetoid spread) SC, nodal metastasis, or palliative care. Cryotherapy and topical chemotherapy are used for pagetoid spread. Targeted therapy has an emerging role in more complicated cases. For lymph node and distant metastasis, combination treatments should be provided, including lymph node and neck dissection, radiation therapy, systemic chemotherapy, and even orbital exenteration. The rarity of ocular SC precludes a comprehensive perspective on standard treatment. This paper offers a brief review of recent advances in the clinical diagnosis and management of ocular SC based on current scientific literature.
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Affiliation(s)
- Yangfan Xu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China, ; .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, People's Republic of China, ;
| | - Fang Li
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China, ; .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, People's Republic of China, ;
| | - Renbing Jia
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China, ; .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, People's Republic of China, ;
| | - Xianqun Fan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China, ; .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, People's Republic of China, ;
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Outcome of 110 Basal Cell Carcinomas of the Eyelid Treated with Frozen Section–Controlled Excision: Mean Follow-up over 5 Years. Eur J Ophthalmol 2018; 24:476-82. [PMID: 24338583 DOI: 10.5301/ejo.5000405] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2013] [Indexed: 11/20/2022]
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25
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Incidence and Clinical Features of Rare Cutaneous Malignancies in Olmsted County, Minnesota, 2000 to 2010. Dermatol Surg 2017; 43:116-124. [PMID: 28027201 DOI: 10.1097/dss.0000000000000936] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The incidence of rare cutaneous malignancies is unknown. Current estimates of rare cutaneous malignancy incidences are based on broad epidemiologic data or single institution experiences, not population-based data. OBJECTIVE To determine the incidence of several rare nonmelanoma skin cancers. MATERIALS AND METHODS The authors conducted a retrospective chart review of a population-based cohort between the years 2000 and 2010. Residents of Olmsted County, Minnesota, who were diagnosed with a biopsy-proven nonmelanoma skin cancer-excluding basal cell carcinoma and squamous cell carcinoma-were included in this study. The primary outcome was tumor incidence. Additionally, the authors extracted patient demographics, tumor characteristics, treatment modalities, and outcomes. RESULTS The age-adjusted and sex-adjusted incidences per 100,000 persons of multiple rare cutaneous malignancies were: atypical fibroxanthoma (1.8), sebaceous carcinoma (0.8), dermatofibrosarcoma protuberans (0.4), microcystic adnexal carcinoma (0.7), eccrine carcinoma (0.4), eccrine porocarcinoma (0.2), and leiomyosarcoma (0.2). CONCLUSION The authors report population-based incidences and clinical characteristics for these rare cutaneous malignancies. The immune status and smoking status of patients and the treatment and outcomes of these tumors are reported. Additional studies in a broader population are needed to further define the epidemiology and outcomes of these malignancies.
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Abstract
BACKGROUND Periocular sebaceous carcinoma (PSC) is a rare but aggressive neoplasm that tends to clinically and histopathologically mimic other conditions. PSC can be challenging to diagnose using histomorphology alone given its overlap with 2 more common tumors that occur in this area (basal cell carcinoma [BCC] and squamous cell carcinoma [SCC]). Use of immunohistochemistry can help resolve this differential diagnosis. METHODS A review of the literature was performed, focusing on the epidemiology, morphology, and immunohistochemical features of PSC. RESULTS The most useful immunostains in the differential diagnosis of PSC are epithelial membrane antigen, Ber-Ep4, androgen receptor (AR), and adipophilin. To discern PSC from BCC, one should use EMA, Ber-Ep4, AR, and adipophilin, whereas discerning PSC from SCC can be achieved by evaluating AR and adipophilin. In addition, p53 and ERBB2 (formally known as HER2/neu) are other potentially useful immunohistochemical markers for the differential diagnosis of PSC. CONCLUSIONS Use of new immunohistochemical techniques, as well as the elucidation of molecular alterations, such as the presence of ERBB2 amplification, will advance our understanding of PSC.
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Affiliation(s)
- Carlos Prieto-Granada
- Department of Dermatology & Cutaneous Surgery, University of South Florida, Tampa, FL 33612, USA.
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Huggins AB, Latting MW, Marx DP, Giacometti JN. Ocular Adnexal Reconstruction for Cutaneous Periocular Malignancies. Semin Plast Surg 2017; 31:22-30. [PMID: 28255286 DOI: 10.1055/s-0037-1598190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Although the majority of lesions present in the periocular region are benign, periocular cutaneous malignancies are certainly not uncommon and must be considered. The management of nonmelanoma cutaneous malignancies is predominately surgical with Mohs micrographic surgery or excision with frozen sections. The approach to reconstruction of the resulting defects depends on the defect location and size. When able, it is preferable to close lesions directly or with the recruitment of adjacent tissue in an effort to preserve the inherent anatomy. The eyelid's dynamic function is thus maintained, which is essential for optimal ocular surface protection. However, larger and more extensive defects will require complex reconstructions that are able to restore the necessary structural integrity to the eyelids. The authors review the various reconstruction approaches for defects of all sizes involving the periocular area including nonmarginal defects and defects of the lower and upper eyelids, as well as those of the medial canthal region.
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Affiliation(s)
- Alison B Huggins
- Department of Ophthalmology, Thomas Jefferson University Hospital, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Michelle W Latting
- Department of Ophthalmology, Thomas Jefferson University Hospital, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Douglas P Marx
- Department of Ophthalmology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Joseph N Giacometti
- Oculoplastic and Orbital Surgery, Morgenstern Center for Orbital and Facial Plastic Surgery, Wayne, Pennsylvania
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Takahashi Y, Takahashi E, Nakakura S, Kitaguchi Y, Mupas-Uy J, Kakizaki H. Risk Factors for Local Recurrence or Metastasis of Eyelid Sebaceous Gland Carcinoma After Wide Excision With Paraffin Section Control. Am J Ophthalmol 2016; 171:67-74. [PMID: 27590119 DOI: 10.1016/j.ajo.2016.08.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/19/2016] [Accepted: 08/20/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To identify risk factors for local recurrence and metastasis of sebaceous gland carcinoma (SGC) after wide excision with paraffin section control. DESIGN Retrospective, observational case-control study. METHODS Setting: Single institution. PATIENT POPULATION Thirty-four patients with SGC who had undergone excision with 5-mm surgical margins and paraffin section pathologic analysis. Observational Procedures: The following were considered potential risk factors for local recurrence/metastasis of SGC: patient's sex, patient's age, initial diagnosis at other clinics, topical treatments at other clinics, interval between appearance of symptoms and referral to our institution, tumor location, tumor origin, tumor presentation pattern, T category, tumor size, presence/or absence of pagetoid spread, tumor differentiation, mitosis grade, growth pattern. Logistic regression analysis was performed to identify the actual risk factors. MAIN OUTCOME MEASURES Risk factors for local recurrence or metastasis of SGC after wide excision with paraffin section control. RESULTS Involvement of both upper and lower eyelids, topical treatments at other clinics, multicentric origin, diffuse pattern, stage T3a, large tumor size, and a nonlobular pattern significantly influenced local recurrence/metastasis (P < .050). Pagetoid spread tended to affect local recurrence/metastasis (P = .052). The other items did not significantly influence local recurrence/metastasis (P > .050). CONCLUSIONS This study identified risk factors for local recurrence or metastasis of SGC after wide excision with paraffin section pathologic analysis. The results of this study will be helpful to surgeons when planning additional management, such as map biopsy or adjuvant treatment.
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Gerring RC, Ott CT, Curry JM, Sargi ZB, Wester ST. Orbital exenteration for advanced periorbital non-melanoma skin cancer: prognostic factors and survival. Eye (Lond) 2016; 31:379-388. [PMID: 27768120 DOI: 10.1038/eye.2016.218] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 09/03/2016] [Indexed: 12/16/2022] Open
Abstract
PurposeTo describe prognostic factors and survival outcomes in patients who underwent orbital exenteration for periocular non-melanoma cutaneous malignancies.MethodsThe authors performed an institutional review board-approved retrospective review of all patients who underwent orbital exenteration for non-melanoma periocular cutaneous malignancies at a tertiary care hospital system over a 10-year period. Patient demographics, tumor, and treatment data were recorded. Survival outcomes included disease-free survival (DFS) and overall survival (OS). Log-rank tests were used to test for difference in survival curves among various potential prognostic indicators, and multivariate analysis was performed using Cox's proportional hazards model.ResultsForty-nine patients with an average age of 70.3 years were followed with a median follow-up of 17.5 months. At 2 years the OS was 78% while the DFS was 61%. The mean DFS for basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and sebaceous gland carcinoma (SGC) were 52.6, 39.2 and 28.1 months, respectively. Multivariate analysis demonstrated that only positive final surgical margin was predictive of worse outcome (P=0.002). Recurrences were most frequent in the first 2 years.ConclusionsDespite the relatively more aggressive nature of periocular malignancies that have invaded the orbit, orbital exenteration offers an overall 2-year DFS of ~60%. BCC had the greatest mean survival time, however this was not statistically significant. We found worse prognosis with positive final surgical margins and recommend a multidisciplinary surgical approach to achieve complete resection when indicated.
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Affiliation(s)
- R C Gerring
- Department of Otolaryngology, Head and Neck Surgery, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA
| | - C T Ott
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - J M Curry
- Department of Otolaryngology, Kimmel Cancer Center and Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Z B Sargi
- Department of Otolaryngology, Head and Neck Surgery, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA
| | - S T Wester
- Department of Ophthalmology, Division of Oculoplastic Surgery, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Abstract
This article evaluates malignant transformation of lesions presenting in the periocular skin under the eye spectacle nose pad. A non-comparative retrospective chart review of clinical features and pathological findings of patients presenting with periocular malignancies in the exact vicinity where the nose pads of their eye spectacles rested was completed. The study took place in one tertiary oculoplastic referral center between 2007-2013. Ten patients were included, six of whom were male. All subjects wore eye spectacles while awake for at least 15 years, and had an evident suspicious lesion in the exact area that coincided with the resting place of the nose pad. The mean age was 73.5 years (range 65-85 years) and all patients had the lesion present for at least one year. Most cases were squamous skin malignancies (five squamous cell carcinomas [SCC], 2 intra-epidermal carcinomas [IEC], while 3 basal cell carcinomas [BCC]). Treatment involved surgical excision of the lesion with frozen section for margin control and reconstruction with a myocutaneous flap. Periocular malignancies of the inferior medial canthal area, where the nose pad of eye spectacle places pressure, can be easily missed or misdiagnosed. Marjolin ulcers (MU) classically present as an aggressive SCC in area of chronic inflammation, which has been previously correlated to constant pressure, repetitive trauma, or non-healing wounds in other areas of the body. We propose that the traumatic chronic pressure in the infero-medial canthal region from long-term eye spectacle nose pad use, may induce poor lymphatic regeneration leading to an immune system deficiency that predisposes this skin to a malignant transformation. The presence of chronic eye spectacle nose pads also prevents proper and timely detection of such malignancies. Complete excision of these lesions with margin control, adequate follow-up for possible recurrence, and surveillance for new lesions on the patient's contralateral side, is crucial for adequate management.
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Affiliation(s)
- Ze Zhang
- a Department of Ophthalmology , Tulane University, Tulane Health Sciences Center , New Orleans , Louisiana , USA
| | - Soroosh Behshad
- a Department of Ophthalmology , Tulane University, Tulane Health Sciences Center , New Orleans , Louisiana , USA
| | - Pooja Sethi-Patel
- a Department of Ophthalmology , Tulane University, Tulane Health Sciences Center , New Orleans , Louisiana , USA
| | - Alejandra A Valenzuela
- a Department of Ophthalmology , Tulane University, Tulane Health Sciences Center , New Orleans , Louisiana , USA
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The Effect of Socio-Economic Status on Severity of Periocular Basal Cell Carcinoma at Presentation. Ophthalmic Plast Reconstr Surg 2016; 31:456-8. [PMID: 25719377 DOI: 10.1097/iop.0000000000000386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the influence of socio-economic factors on size of periocular basal cell carcinoma at presentation. METHODS All periocular basal cell carcinoma cases receiving treatment from the oculoplastics team in South Glasgow Hospitals NHS Trust, Glasgow, between 1999 and 2009, were identified retrospectively. Information collected included demographic details of patients, side and site of lesions, type of lesions, and size of lesions. The size of lesion was defined as small for any dimension not exceeding 5 mm, medium for dimensions between 6 mm and 10 mm, and large for dimensions exceeding 11 mm. Home address was used to determine the Scottish Index of Multiple Deprivation rank. The demographics, size of lesion, and Scottish Index of Multiple Deprivation rank were investigated using the general linear regression modelling. RESULTS Of the 67 cases, 24 were men and 43 were women. The mean age was 71.5 years. There were a total of 67 identified cases, of which 38 presented with small-size lesions, 24 with medium-size lesions, and 5 with large-size lesions. Scottish Index of Multiple Deprivation is related to the presenting incidence of basal cell carcinoma, with the lower ranks presenting more frequently. CONCLUSIONS Socio-economic deprivation is associated with larger and more frequent presentation of periocular basal cell carcinoma. This highlights the importance of raising awareness among populations of the more deprived areas of the significance of lumps and bumps within the periocular regions.
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Abstract
Cutaneous malignancies make up the majority of periocular tumors diagnosed and treated by ophthalmologists. In this review, we examine literature regarding ethnic and socioeconomic disparities in incidence and clinical outcomes of the three most common cutaneous periocular tumors: basal cell carcinoma, squamous cell carcinoma, and melanoma. In all three tumor types, the literature shows an increased incidence among two groups: those with lightly pigmented skin and those of higher socioeconomic status. While incidence is high in these groups, clinical outcomes for these patients tend to be good. Those with lower socioeconomic status and ethnic minorities, on the other hand, have a low incidence but are more likely to have poor clinical outcomes. These disparities are likely the result of both biologic and behavioral differences between patients and could provide opportunities for intervention to change risk perception and improve outcomes.
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Affiliation(s)
- Talmage Broadbent
- a Vanderbilt Eye Institute , Vanderbilt University, Nashville , TN , USA
| | - Brian Bingham
- a Vanderbilt Eye Institute , Vanderbilt University, Nashville , TN , USA
| | - Louise A Mawn
- a Vanderbilt Eye Institute , Vanderbilt University, Nashville , TN , USA
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Huang G, Mirani N, Connally A, Langer PD. Successful Treatment of Extensive Squamous Cell Carcinoma of the Conjunctiva and Upper Eyelid Skin With Topical Therapy Alone. Ophthalmic Plast Reconstr Surg 2015; 33:S4-S6. [PMID: 26669290 DOI: 10.1097/iop.0000000000000601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This study reports a case of extensive periocular squamous cell carcinoma of the conjunctiva, extending into the superior fornix, over the upper eyelid margin, and involving the superficial layers of the eyelid skin up to the eyebrow, that was successfully treated solely with topical therapy.
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Affiliation(s)
- Grace Huang
- *The Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey; †Department of Pathology, Rutgers New Jersey Medical School, Newark, New Jersey; and ‡Section of Dermatology, St. Barnabas Hospital, Livingston, New Jersey, U.S.A
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Gaitanis G, Kalogeropoulos CD, Bassukas ID. Cryosurgery during Imiquimod (Immunocryosurgery) for Periocular Basal Cell Carcinomas: An Efficacious Minimally Invasive Treatment Alternative. Dermatology 2015; 232:17-21. [PMID: 26583773 DOI: 10.1159/000441491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/06/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM Periocular basal cell carcinomas (pBCC) remain a treatment challenge. Our aim was to retrospectively evaluate the feasibility and efficacy of immunocryosurgery for the treatment of pBCC. METHODS Immunocryosurgery is given in 5-week cycles of daily imiquimod, with cryosurgery on day 14. Patients treated between 1/1/2008 and 31/12/2014 were included in this study. RESULTS Immunocryosurgery was offered to 19 patients. Of these, 16 (i.e., 6 males and 10 females, average age 74.9 years, median tumor diameter 15 mm, range 5-60 mm), with 1 tumor each, were treated. Six tumors (37.5%) were relapses after surgery and 2 were of metatypical histology. All BCC were high risk for recurrence after treatment; 10 tumors had 2 risk factors for relapse, 5 had 3, and 1 had 4. The follow-up period ranged between 3 and 60 months (average 25.6 months). Of the 16 tumors treated, 14 (all with a diameter <40 mm) cleared with immunocryosurgery (total efficacy 87.5%); 7 out of 16 tumors (44%; all with a diameter ≤20 mm) cleared with 1 conventional 5-week immunocryosurgery treatment cycle. Seven additional tumors (including 2 with a diameter >20 mm) required intensified treatment schemes (of up to 10 weeks) for clearance. The 2 tumors that did not clear responded partially and were also the 2 largest ones (diameter 40 and 60 mm). Of the 14 cleared tumors, 2 relapsed during follow-up; 1 cleared with immunocryosurgery. At the last examination during follow-up, 13 out of 16 (81%) patients were in sustained clinical remission. CONCLUSIONS For most pBCC, immunocryosurgery is a feasible and efficacious alternative to surgical excision.
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Affiliation(s)
- Georgios Gaitanis
- Department of Skin and Venereal Diseases, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
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Perry JD, Polito SC, Chundury RV, Singh AD, Fritz MA, Vidimos AT, Gastman BR, Koyfman SA. Periocular Skin Cancer in Solid Organ Transplant Recipients. Ophthalmology 2015; 123:203-8. [PMID: 26520170 DOI: 10.1016/j.ophtha.2015.09.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/22/2015] [Accepted: 09/23/2015] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To determine the proportion of solid organ transplant recipients developing periocular nonmelanoma skin cancer and to describe the morbidity of these cancers in transplant recipients. DESIGN Cohort study. PARTICIPANTS Consecutive patients undergoing solid organ transplantation at the Cleveland Clinic between 1990 and 2008. METHODS The charts of all patients receiving a solid organ transplant from 1990-2008 evaluated in the dermatology department for a subsequent biopsy-proven head and neck malignancy through April 2015 were reviewed. Patients with a periocular region nonmelanoma skin cancer (NMSC) or a nonperiocular NMSC causing a complication requiring eyelid surgery were included. Charts were reviewed for demographic data; transplant date, type, and source; immunosuppressive agents received at diagnosis; and type of NMSC, number of nonperiocular NMSCs, ophthalmologic findings, and periocular sequelae after the repair. MAIN OUTCOME MEASURES Primary outcome measures included the type, location, final defect size, tumor-node-metastasis classification, presence of perineural invasion, and reconstruction technique(s) used for each periocular NMSC. Secondary outcome measures included the type and treatment of ocular sequelae due to nonperiocular facial NMSC. RESULTS A total of 3489 patients underwent solid organ transplantation between 1990 and 2008. Of these, 420 patients were evaluated in the dermatology clinic for biopsy-proven NMSC of the head and neck during the study period, and 11 patients (15 malignancies) met inclusion criteria. Nine patients developed 12 periocular malignancies and 3 patients required eyelid surgery for facial malignancies outside the periocular zone. All 11 patients developed a squamous cell carcinoma (14 malignancies), and 1 patient (1 malignancy) also developed a periocular basal cell carcinoma. There was orbital invasion in 4 cases and paranasal and/or cavernous sinus invasion in 3 cases. Two patients underwent exenteration. Seven cases required reconstruction with a free flap or graft. Periocular sequelae included lower eyelid ectropion (6 malignancies), dry eye and/or exposure symptoms (8 malignancies), unilateral vision loss (3 malignancies), and facial nerve paresis (5 malignancies). CONCLUSIONS Squamous cell carcinoma affecting the periocular region represents a risk of solid organ transplantation and may produce significant ocular morbidity, including the need for major eyelid reconstruction, globe loss, and disfiguring surgery.
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Affiliation(s)
| | - Sara C Polito
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Arun D Singh
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael A Fritz
- Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio
| | | | - Brian R Gastman
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
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Sun MT, Wu A, Figueira E, Huilgol S, Selva D. Management of periorbital basal cell carcinoma with orbital invasion. Future Oncol 2015; 11:3003-10. [PMID: 26437207 DOI: 10.2217/fon.15.190] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Basal cell carcinoma (BCC) is the most common eyelid malignancy; however, orbital invasion by periocular BCC is rare, and management remains challenging. Established risk factors for orbital invasion by BCC include male gender, advanced age, medial canthal location, previous recurrences, large tumor size, aggressive histologic subtype and perineural invasion. Management requires a multidisciplinary approach with orbital exenteration remaining the treatment of choice. Globe-sparing treatment may be appropriate in selected patients and radiotherapy and chemotherapy are often used as adjuvant therapies for advanced or inoperable cases, although the evidence remains limited. We aim to summarize the presentation and treatment of BCC with orbital invasion to better guide the management of this complex condition.
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Affiliation(s)
- Michelle T Sun
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital & University of Adelaide, Adelaide, South Australia 5000, Australia
| | - Albert Wu
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital & University of Adelaide, Adelaide, South Australia 5000, Australia
| | - Edwin Figueira
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital & University of Adelaide, Adelaide, South Australia 5000, Australia
| | - Shyamala Huilgol
- Department of Dermatology, Royal Adelaide Hospital & University of Adelaide, Adelaide, South Australia 5000, Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital & University of Adelaide, Adelaide, South Australia 5000, Australia
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Ozgur OK, Yin V, Chou E, Ball S, Kies M, William WN, Migden M, Thuro BA, Esmaeli B. Hedgehog Pathway Inhibition for Locally Advanced Periocular Basal Cell Carcinoma and Basal Cell Nevus Syndrome. Am J Ophthalmol 2015; 160:220-227.e2. [PMID: 25935097 DOI: 10.1016/j.ajo.2015.04.040] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 04/23/2015] [Accepted: 04/27/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE To review our experience treating patients with the Hedgehog pathway inhibitor, vismodegib, in patients with orbital or periocular locally advanced or metastatic basal cell carcinoma (BCC) or basal cell nevus syndrome. DESIGN Retrospective interventional case series. METHODS We reviewed all patients with locally advanced or metastatic orbital or periocular BCC or basal cell nevus syndrome treated with the Hedgehog pathway inhibitor, vismodegib, at a comprehensive cancer center from 2009 through 2015. Reviewed data included age; sex; American Joint Commission on Cancer tumor, node, metastasis staging system designation; type and grade of drug-related side effects; response to treatment; duration of follow-up, and status at last follow-up. RESULTS The study included 10 white men and 2 white women; the median age was 64.5 years. Ten patients had locally advanced BCC; 2 had basal cell nevus syndrome. Among the patients with locally advanced BCC, 5 had T3bN0M0 disease at presentation; 1 each had T3aN0M0, T3bN1M0, T2N1M1, T4N1M1, and T4N2cM1 disease. Overall, 3 patients had a complete response, 6 had a partial response, and 3 had stable disease at last follow-up. Two patients developed progressive disease after a complete response for 38 months and stable disease for 16 months, respectively. All patients developed grade I drug-related adverse effects, most commonly muscle spasms (12 patients), weight loss (10), dysgeusia (9), alopecia (9), decreased appetite (5), and fatigue (4). Five patients developed grade II adverse effects. At last follow-up, none of the 5 patients presenting with T3bN0M0, nor the patient with T3bN1M0 disease, had required orbital exenteration. CONCLUSION Hedgehog pathway inhibition produces a significant clinical response in most patients with locally advanced or metastatic orbital or periocular BCC or basal cell nevus syndrome and can obviate orbital exenteration in some patients. Drug-related adverse effects are manageable in most patients.
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Affiliation(s)
- Omar K Ozgur
- Department of Plastic Surgery, Orbital Oncology and Ophthalmic Plastic Surgery Program, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vivian Yin
- Department of Plastic Surgery, Orbital Oncology and Ophthalmic Plastic Surgery Program, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eva Chou
- Department of Plastic Surgery, Orbital Oncology and Ophthalmic Plastic Surgery Program, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sharon Ball
- Department of Plastic Surgery, Orbital Oncology and Ophthalmic Plastic Surgery Program, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Merrill Kies
- Department of Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William N William
- Department of Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael Migden
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bradley A Thuro
- Department of Plastic Surgery, Orbital Oncology and Ophthalmic Plastic Surgery Program, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bita Esmaeli
- Department of Plastic Surgery, Orbital Oncology and Ophthalmic Plastic Surgery Program, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Treacy MP, Wynne NC, Gale JL, Duignan E, Moran B, Flynn AM, Ormond P, Barry R, Khan R, Moriarty P, Cassidy L. Mohs micrographic surgery for periocular skin tumours in Ireland. Ir J Med Sci 2015; 185:779-783. [PMID: 26159430 DOI: 10.1007/s11845-015-1296-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe the shared care and outcomes of patients with periocular skin tumours who underwent Mohs micrographic surgery (MMS) performed by dermatologists, followed by oculoplastic reconstruction undertaken by ophthalmologists at two teaching and one private hospital in Ireland. RESEARCH DESIGN AND METHODS This was a retrospective chart review at the Royal Victoria Eye and Ear Hospital, St James Hospital and the Hermitage Clinic. RESULTS One hundred and twenty seven patients had periocular Mohs surgery between November 2006 and January 2013 mainly indicated for basal cell carcinoma. The mean follow-up time was 2 years and to date there have been no local recurrences. CONCLUSIONS MMS is available in Ireland and should be considered for patients with facial tumours in the ocular region.
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Affiliation(s)
- M P Treacy
- Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin, 2, Ireland, Ireland
| | - N C Wynne
- Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin, 2, Ireland, Ireland.
| | - J L Gale
- Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin, 2, Ireland, Ireland
| | - E Duignan
- Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin, 2, Ireland, Ireland
| | - B Moran
- Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin, 2, Ireland, Ireland
| | - A M Flynn
- Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin, 2, Ireland, Ireland.,St James Hospital, James Street, Dublin, 8, Ireland
| | - P Ormond
- Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin, 2, Ireland, Ireland.,St James Hospital, James Street, Dublin, 8, Ireland
| | - R Barry
- Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin, 2, Ireland, Ireland.,St James Hospital, James Street, Dublin, 8, Ireland
| | - R Khan
- Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin, 2, Ireland, Ireland
| | - P Moriarty
- Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin, 2, Ireland, Ireland
| | - L Cassidy
- Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin, 2, Ireland, Ireland
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Abstract
BACKGROUND Sebaceous carcinoma is an uncommon adnexal neoplasm with a documented capability for regional and distant metastasis. Traditionally, sebaceous carcinoma has been associated with high rates of recurrence after excision. OBJECTIVE To review the current literature on sebaceous carcinoma and detail its epidemiology, pathogenesis, clinical presentation, histopathology, diagnostic workup, treatment, and prognosis. MATERIALS AND METHODS Literature review using PubMed search for articles related to sebaceous carcinoma. RESULTS Sebaceous carcinoma typically presents as a painless pink or yellow nodule. Diagnosis requires histopathologic examination, and immunohistochemical analysis often assists in the differentiation of sebaceous carcinoma from other benign and malignant skin neoplasms. Sebaceous carcinoma should prompt a workup for Muir-Torre syndrome. Periorbital sebaceous carcinoma has an increased tendency for regional metastasis, although cancer-specific mortality rates are similar among all anatomic locations. CONCLUSION Surgery is the preferred treatment for local disease. Limited data suggest that Mohs micrographic surgery may provide superior clinical outcomes, but more research is needed regarding the long-term outcomes. Radiation and systemic chemotherapy are reserved for recurrent or metastatic disease.
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Abstract
BACKGROUND The Frost suture is a well-known surgical technique for providing upward tension on the lower lid to prevent or correct ectropion after surgical interventions in the periorbital area. Despite its relatively common use, comprehensive information on executing this technique is not readily available. OBJECTIVE To review eyelid anatomy, indications, and proper technique for performing the Frost suture, as well as potential complications. MATERIALS AND METHODS A review of the literature on Frost sutures was performed. Cadaveric dissection was performed to demonstrate placement of the Frost suture. RESULTS AND CONCLUSION The Frost suture is a useful method to reduce the risk of ectropion after surgery near the lower eyelid. Downward pull on the lid can occur with normal wound contracture even if ectropion is not present with the initial repair, reinforcing the need for preventive measures. Potential complications of this technique include superficial skin erosion of the upper lid, corneal abrasion, and blockage of the field of vision while the suture is in place.
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Iglesias ME, Santesteban R, Larumbe A. Oncologic surgery of the eyelid and orbital region. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:365-75. [PMID: 25701895 DOI: 10.1016/j.ad.2014.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/28/2014] [Accepted: 11/09/2014] [Indexed: 10/24/2022] Open
Abstract
Oncologic surgery of the eyelid and orbital region is a challenge in dermatologic surgery. This region presents difficulties and possible complications that do not exist at other sites, including ectropion, epiphora, corneal exposure, keratitis, conjunctivitis, and lagophthalmos. Adequate oncologic surgery associated with the best possible functional and cosmetic result requires extensive knowledge of the anatomy, innervation, and blood supply of the eyelid and anatomy of the lacrimal apparatus. We present examples of reconstructive surgical techniques that can be used after the excision of tumors of the upper or lower eyelid, with descriptions of the different flaps and grafts employed in our department in recent years. We also review the surgical techniques according to the site and size of the lesions.
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Affiliation(s)
- M E Iglesias
- Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, España
| | - R Santesteban
- Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, España.
| | - A Larumbe
- Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, España
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Lynde C, Gunton L, Weinberg T, Murray C. Periorbital surface anatomy for the dermatologist. J Cutan Med Surg 2014; 18:141-4. [PMID: 24636442 DOI: 10.2310/7750.2013.13135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Optimal management of skin pathology demands accurate anatomic description, especially in the orbit and periorbital region. CASE REPORT This brief article reviews the clinically important surface anatomy of the orbit and periorbital region for the dermatologist.
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Targeted therapy for orbital and periocular basal cell carcinoma and squamous cell carcinoma. Ophthalmic Plast Reconstr Surg 2013; 29:87-92. [PMID: 23446297 DOI: 10.1097/iop.0b013e3182831bf3] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To review the literature on targeted therapy for orbital and periocular basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) and provide examples of patients recently treated with such therapy. METHODS The authors reviewed the literature on clinical results of targeted therapy and the molecular basis for targeted therapy in orbital and periocular BCC and cutaneous SCC. The authors also present representative cases from their practice. RESULTS Mutation in the patched 1 gene (PTCH1) has been implicated in BCC, and overexpression of epidermal growth factor receptor (EGFR) has been shown in SCC. Vismodegib, an inhibitor of smoothened, which is activated upon binding of hedgehog to Ptc, has been shown to significantly decrease BCC tumor size or even produce complete resolution, especially in cases of basal cell nevus syndrome. Similarly, EGFR inhibitors have been shown to significantly decrease SCC tumor size in cases of locally advanced and metastatic disease. The authors describe successful outcomes after vismodegib treatment in a patient with basal cell nevus syndrome with numerous bulky lesions of the eyelid and periocular region and erlotinib (EGFR inhibitor) treatment in a patient with SCC who was deemed not to be a good surgical candidate because of advanced SCC of the orbit with metastasis to the regional lymph nodes, advanced age, and multiple medical comorbidities. CONCLUSIONS Targeted therapy using hedgehog pathway and EGFR inhibitors shows significant promise in treatment of orbital and periocular BCC and cutaneous SCC, respectively. Such targeted therapy may be appropriate for patients who are not good candidates for surgery.
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Harvey DT, Taylor RS, Itani KM, Loewinger RJ. Mohs micrographic surgery of the eyelid: an overview of anatomy, pathophysiology, and reconstruction options. Dermatol Surg 2012; 39:673-97. [PMID: 23279119 DOI: 10.1111/dsu.12084] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- David T Harvey
- Department of Dermatology, Dermatologic Surgery, University of Texas Southwestern, Dallas, Texas, USA.
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