1
|
Attal ZG, Shalata W, Soklakova A, Tourkey L, Shalata S, Abu Saleh O, Abu Salamah F, Alatawneh I, Yakobson A. Advanced and Metastatic Non-Melanoma Skin Cancer: Epidemiology, Risk Factors, Clinical Features, and Treatment Options. Biomedicines 2024; 12:1448. [PMID: 39062023 PMCID: PMC11274597 DOI: 10.3390/biomedicines12071448] [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: 05/20/2024] [Revised: 06/27/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Non-melanoma skin cancers (NMSC) form the majority of skin cancers, with basal cell carcinoma (BCC) being the most common and cutaneous squamous cell carcinoma (cSCC) being second. Prolonged ultraviolet (UV) exposure, aging, male gender, and immunosuppression represent most of the causes of this category of diseases. BCCs and cSCCs both include different types of skin cancers, such as nodular or morpheaform BCC or flat cSCC. Locally advanced and metastatic NMSCs cannot be treated surgically; thus, systemic therapy (TKI and Immunotherapy) is needed. Interestingly, NMSCs are frequently linked to abnormal Hedgehog (HH) signaling which most systemic immunotherapies for these cancers are based upon. Of note, the first line therapies of BCC, sonidegib and vismodegib, are HH inhibitors. Programmed death receptor 1 antibody (PD-1) inhibitors such as cemiplimab, pembrolizumab, and nivolumab have been approved for the treatment of cSCC. Thus, this paper reviews the epidemiology, risk factors, clinical features, and treatment options for both BCC and cSCC.
Collapse
Affiliation(s)
- Zoe Gabrielle Attal
- Medical School for International Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
| | - Walid Shalata
- The Legacy Heritage Center, Dr Larry Norton Institute, Soroka Medical Center, Ben Gurion University, Beer Sheva 84105, Israel
| | - Arina Soklakova
- Medical School for International Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
| | - Lena Tourkey
- Medical School for International Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
| | - Sondos Shalata
- Nutrition Unit, Galilee Medical Center, Nahariya 22000, Israel
| | - Omar Abu Saleh
- Department of Dermatology and Venereology, The Emek Medical Centre, Afula 18341, Israel
| | - Fahed Abu Salamah
- Department of Dermatology, Soroka Medical Center and Ben Gurion University, Beer Sheva 84105, Israel
| | - Ibrahim Alatawneh
- Department of Dermatology, Soroka Medical Center and Ben Gurion University, Beer Sheva 84105, Israel
| | - Alexander Yakobson
- Medical School for International Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
| |
Collapse
|
2
|
Lin Z, Sheikh U, Igali L, Hemmant B. A 5-year review of 1220 malignant periocular tumours in an English county. Eye (Lond) 2023; 37:1271-1274. [PMID: 35614342 PMCID: PMC10102031 DOI: 10.1038/s41433-022-02113-3] [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: 12/07/2021] [Revised: 04/27/2022] [Accepted: 05/13/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES To determine the incidence, proportion and location of periocular tumours in an English county over a five year period, and compare to other studies in the UK and worldwide. SUBJECTS/METHODS A retrospective review of histopathology reports was performed for all periocular excision biopsies of malignancies from the county's three main hospitals over a 5-year period. These hospitals cover a population of just over one million. Tumours were classified according to type and location. RESULTS 1220 lesions were included in this study. Right-sided lesions were more common than left. The incidence of basal cell carcinoma was 22 per 100,000 and squamous cell carcinoma 1.3 per 100,000, which were found most commonly on the lower eyelid and eyebrow respectively. The incidences of all other types of lesions were less than 0.5 per 100,000 per year. CONCLUSIONS The incidence of periocular basal cell carcinomas in the predominantly elderly Caucasian population was at least three times the published national average. The high incidence of periocular tumours in this North East Anglian county is set to increase further as the proportion of over 65 year olds in the population is predicted to nearly double within two decades.
Collapse
Affiliation(s)
- Zhiheng Lin
- University Hospital Southampton, Southampton, UK.
| | - Umair Sheikh
- James Paget University Hospital, Great Yarmouth, UK
| | - Laszlo Igali
- Norfolk and Norwich University Hospital, Norwich, UK
| | - Bridget Hemmant
- James Paget University Hospital, Great Yarmouth, UK
- University of East Anglia, Norwich, UK
| |
Collapse
|
3
|
Dethmers A, Löw U, Langenbucher A, Flockerzi F, Bohle RM, Seitz B. [Recurrence risk of periocular basal cell carcinoma after histologically controlled excision]. DIE OPHTHALMOLOGIE 2023; 120:285-293. [PMID: 36112203 DOI: 10.1007/s00347-022-01719-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE The incidence of basal cell carcinoma (BCC) has significantly increased in the last decades. The aim of this retrospective study was to determine the risk of recurrence of periocular BCC after histologically controlled resection. PATIENTS AND METHODS Based on the clinical records from 2009-2020 a total of 270 consecutive periocular BCCs from 243 patients were investigated with respect to recurrence after surgical excision. For this study, the type of BCC (primary or recurrent BCC) and localization within the orbital region (upper eyelid nasal, middle, temporal and lower eyelid nasal, middle, temporal) and the histological BCC subtype, e.g. solid/nodular (s/n), superficial multicentric (s-m), infiltrative/sclerodermal (i/s), basosquamous (bsq) and mixed (gem), were recorded. Recurrence rates were compared using χ2-tests. RESULTS The 270 resected BCCs with 231 primary BCC (pBCC) and 39 already recurrent BCC (rBCC), were included in this study. Among the 231 pBCCs we recorded a total of 38 (16.5%, 2‑year recurrence rate 9.2%) recurrences for the abovementioned period. In the 39 rBCCs we observed 18 (46.2%) recurrences (2-year recurrence rate 37.8%). In addition, a significantly shorter recurrence-free interval (RFV, ∅ 52.6 ± 9.0 months) was observed for the rBCC than for the pBCC (∅108.6 ± 4.1 months, p < 0.001). The recurrence rates did not differ significantly with respect to the location; however, there was a significant difference between the five defined subtypes (p = 0.001): s/n = 15.9%, s‑m = 45.0%, i/s = 27.8%, bsq = 33.3% and gem = 40.0%. After R0 resection the recurrence rate of s/n BCC was significantly lower than after R?/R1 resection (p = 0.008). The histological subtypes i/s (p = 0.433), bsq (p = 0.417), and gem (p = 0.143), showed no significant difference between the recurrence rates after R0 and R?/R1 resection. In s‑m BCC, a conclusion on the statistical significance was not possible. DISCUSSION The recurrence rate appears to be comparatively high; however, R1 resected BCCs were intentionally included in this study to obtain an evaluation that reflects clinical practice as realistically as possible. It is possible that the surgical procedure and/or the type of histological examination as well as the broad interpretation of the term local recurrence could be the reason for the different recurrence data in the literature. Our data indicate that the recurrence rate is not affected by the exact localization within the orbital region, but by the respective BCC subtype. As recurrences may develop years after BCC excision a long-term follow-up is strictly recommended.
Collapse
Affiliation(s)
- Arianna Dethmers
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland.
| | - Ursula Löw
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - Achim Langenbucher
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - Fidelis Flockerzi
- Institut für Allgemeine und Spezielle Pathologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Rainer M Bohle
- Institut für Allgemeine und Spezielle Pathologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| |
Collapse
|
4
|
Hassanin F, Al Hussain H, Maktabi A, Adly N, Alsuabeyl M, Abedalthagafi M, Edward DP, Strianese D. Periocular Pigmented Basal Cell Carcinomas: Clinicopathologic Features and Mutational Profile. Ophthalmic Plast Reconstr Surg 2022; 38:475-482. [PMID: 35699213 DOI: 10.1097/iop.0000000000002173] [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: 11/26/2022]
Abstract
PURPOSE Pigmented basal cell carcinomas (PBCC) is an uncommon variant of basal cell carcinoma of the periocular region with limited information in the literature. We highlight the clinicopathological profile and somatic mutations in periocular PBCC. METHODS The clinicopathological features and somatic mutations in patients with periocular PBCC were examined and compared with periocular non-PBCC reported in the literature. Next-generation sequencing panel analysis for the excised tumors identified somatic mutations. RESULTS In a total of 31 patients, PBCC was common in females (54%; p = 0.03); as a unilateral lower eyelid (n = 22; 71%), solitary mass (n = 30; 98%). Pathologic subtypes were variable. Most were nodular or mixed variants (n = 23; 74%). During the follow up (2.5-4.5 years), 1 patient (3.5%) had a recurrence. The clinical and pathologic features of PBCC were similar to those reported in nonperiocular locations. Somatic mutations detected in 25/31 tumors. Variants in 50/161 genes in the panel were noted. PTCH1 (14/31), TERT (12/31), and SMO (7/31) variants were common. Fifteen patients had novel drivers, including POLE, FANCD2, and CREBBP. SMO mutations were significantly more common in females (7/7), lower eyelid (5/7), and TERT mutations were more common in nodular subtype (10/12). CONCLUSIONS In this large cohort of a relatively uncommon variant of BCC, the clinicopathological features and tumor behavior of PBCC was similar to periocular non-PBCC. The somatic mutation spectrum of PBCC resembles that reported in nonperiocular cutaneous BCC with novel drivers identified. We identified several potential actionable mutations that could be targeted with molecular therapy.
Collapse
Affiliation(s)
- Fadi Hassanin
- King Khaled Eye Specialty Hospital, Riyadh, Saudi Arabia
- Department of Ophthalmology, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | | | - Azza Maktabi
- King Khaled Eye Specialty Hospital, Riyadh, Saudi Arabia
| | - Nouran Adly
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz, City for Science and Technology, Riyadh, Saudi Arabia
| | - Mohammad Alsuabeyl
- Life Science and Environmental Institute, King Abdulaziz, City for Science and Technology, Riyadh, Saudi Arabia
| | - Malak Abedalthagafi
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz, City for Science and Technology, Riyadh, Saudi Arabia
| | - Deepak P Edward
- King Khaled Eye Specialty Hospital, Riyadh, Saudi Arabia
- Department of Ophthalmology and Visual Sciences and Pathology, University of Illinois College of Medicine, Chicago, Illinois, U.S.A
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | | |
Collapse
|
5
|
Amos-Arowoshegbe EO, Varghese R, Joseph AB, Kanu-Ivi C, Sadi N, Sadana S, Latif F, Abdul A, Ratra R, Blume K, Tiesenga F. Basal Cell Cancer of the Scalp. Cureus 2022; 14:e26469. [PMID: 35919367 PMCID: PMC9338841 DOI: 10.7759/cureus.26469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/05/2022] Open
|
6
|
Kahana A, Bartley K, Meyer CS, Seetasith A, Lee J, McKenna E. Healthcare Resource Utilization and Cost of Care in Patients With Periocular Basal Cell Carcinoma: A Real-World Study. Am J Ophthalmol 2022; 236:164-171. [PMID: 34695403 DOI: 10.1016/j.ajo.2021.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/08/2021] [Accepted: 10/09/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To date, there are no studies on healthcare resource utilization (HRU) and costs for treating periocular basal cell carcinoma (pBCC). We investigated real-world HRU and costs of patients with limited versus extensive pBCC. DESIGN This was a retrospective cost analysis. METHODS Administrative claims database was mined for basal cell carcinoma (BCC)-related claims from January 2011 to December 2018. Patients had ≥1 inpatient or ≥2 outpatient nondiagnostic claims for pBCC ≥30 days apart, ≥6 months of continuous enrollment in a health plan before the index date, and ≥18 months of continuous enrollment after the index date. Patients were categorized by disease severity (limited or extensive) using Current Procedural Terminology codes. A total of 1368 patients were propensity matched 1:1 for limited and extensive pBCC (n = 684 each). Outcomes were cost and HRU measures during the 18-month follow-up period. RESULTS Patients with extensive disease had a higher number of outpatient visits (32.47 vs 28.81; P < .0001), radiation therapies (0.53 vs 0.17; P = .001), surgeries (1.82 vs 1.24; P < .001), days between first and last surgery (40.82 vs 16.51 days; P < .001), outpatient pBCC claims (3.89 vs 3.38; P < .001), and days between pBCC claims (170.43 vs 144.01 days; P < .001). Patients with extensive disease incurred higher total all-cause costs ($36,986.10 vs $31,893.13; P = .02), outpatient costs ($20,450.26 vs $16,885.87; P = .005), radiation therapy costs ($314.28 vs $89.81; P = .01), and surgery costs ($3,697.08 vs $2,585.80; P < .001) than patients with limited disease. CONCLUSIONS Patients with extensive pBCC incurred higher costs, greater HRU, and longer time between first and last surgery versus patients with limited pBCC. Early diagnosis and early treatment of pBCC have economic benefits.
Collapse
Affiliation(s)
- Alon Kahana
- From Oakland University William Beaumont School of Medicine (A.K), Rochester, Michigan, USA; Consultants in Ophthalmic and Facial Plastic Surgery (A.K), Southfield, Michigan, USA.
| | - Karen Bartley
- Genentech, Inc. (K.B, C.S.M, A.S, J.L., EM), South San Francisco, California, USA
| | - Craig S Meyer
- Genentech, Inc. (K.B, C.S.M, A.S, J.L., EM), South San Francisco, California, USA
| | - Arpamas Seetasith
- Genentech, Inc. (K.B, C.S.M, A.S, J.L., EM), South San Francisco, California, USA
| | - Janet Lee
- Genentech, Inc. (K.B, C.S.M, A.S, J.L., EM), South San Francisco, California, USA
| | - Edward McKenna
- Genentech, Inc. (K.B, C.S.M, A.S, J.L., EM), South San Francisco, California, USA
| |
Collapse
|
7
|
Gąsiorowski K, Iwulska K, Zapała J, Wyszyńska-Pawelec G. Periocular basal cell carcinoma: recurrence risk factors/when to reoperate? Postepy Dermatol Alergol 2020; 37:927-931. [PMID: 33603611 PMCID: PMC7874855 DOI: 10.5114/ada.2020.102109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/28/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim of periocular basal cell carcinoma (BCC) surgery is radical excision of the tumour while maintaining eyelid functionality and facial aesthetics. Differences in management of the patients after excision of eyelid BCC with a narrow margin are described in the literature. AIM This study concerns the correlation between the recurrence rate in the periorbital area and the narrow safety margin of excision in the histopathological report with respect to various clinical and histopathological features. MATERIAL AND METHODS A retrospective non-randomized analysis was conducted on 158 patients with BCC of the periorbital area. These patients were operated on between January 2002 and December 2016. A database was created, comprised of patient age, sex, location of the lesion, TNM, method of reconstruction, result of the histopathological examination, date and location of the recurrence. RESULTS In 66 (41.77%) patients BCC was radically removed. In 50 (31.65%) patients BCC was removed with a narrow margin and in 42 (26.58%) cases, radical excision was not achieved. The recurrence rate was significantly higher in the aggressive BCC group compared to those with non-aggressive BCC (p = 0.004). The recurrence-free rate for non-aggressive subtypes was 98.11% in both the first and fifth years, but in aggressive subtypes it was 89.06% in the first year but fell to 80.16% in the fifth year. CONCLUSIONS An aggressive subtype of BCC significantly influences the risk of non-radical excision of the lesion. Aggressive BCC subtypes should have more frequent check-ups. There is no need to reoperate patients with a narrow margin of BCC excision.
Collapse
Affiliation(s)
- Krzysztof Gąsiorowski
- Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, The University Hospital, Krakow, Poland
| | - Katarzyna Iwulska
- Department of Maxillofacial Surgery, L. Rydygier Hospital, Krakow, Poland
| | - Jan Zapała
- Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, The University Hospital, Krakow, Poland
| | - Grażyna Wyszyńska-Pawelec
- Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, The University Hospital, Krakow, Poland
| |
Collapse
|
8
|
Eren MA, Gündüz AK. Demographic features and histopathological diagnosis in primary eyelid tumors: results over 19 years from a tertiary center in Ankara, Turkey. Int J Ophthalmol 2020; 13:1287-1293. [PMID: 32821684 DOI: 10.18240/ijo.2020.08.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 06/11/2020] [Indexed: 01/13/2023] Open
Abstract
AIM To evaluate the demographic features, location, and histopathologic results in primary eyelid tumors. METHODS We retrospectively reviewed the records of patients with primary eyelid tumor diagnosed and treated between November 1997 and June 2016 on our service. RESULTS Nine hundred and eleven lesions from 874 patients were included in this study. Four hundred and forty-six (51.0%) of the patients were females and 428 (49.0%) were males. The mean age was 51.0y (range: 3mo-94y). The lesions were located in the upper eyelid (418 cases, 45.9%), lower eyelid (378 cases, 41.5%), medial canthus (89 cases, 9.8%), and lateral canthus (26 cases, 2.8%). Four hundred and seventy (51.6%) lesions were located on the right side and 441 (48.4%) on the left. Of the eyelid lesions, 666 (73.1%) were benign, 230 (25.2%) malignant, and 15 (1.6%) premalignant. When the eyelid tumors were classified according to their tissue or cell of origin, 527 (57.8%) of the lesions were found to be epidermal, 171 (18.8%) adnexal, 131 (14.4%) inflammatory and infectious, and 65 (7.1%) stromal. The most common benign lesions were squamous cell papilloma (139 lesions, 15.2%), intradermal nevus (97 lesions, 10.6%), epidermoid inclusion cysts (78 lesions, 8.6%), seborrheic keratosis (60 lesions, 6.6%), and inflammatory masses (59 lesions, 6.5%). Basal cell carcinoma was the most common malignant tumor (191 lesions, 21.0%) followed by squamous cell carcinoma (16 lesions, 1.8%), sebaceous carcinoma (14 lesions, 1.5%), and malignant melanoma (5 lesions, 0.5%). CONCLUSION In this study, 73.1% of eyelid lesions are benign and the remaining 26.9% are premalignant and malignant. Basal cell carcinoma is the most common tumor among all histopathological diagnosis followed by squamous papilloma.
Collapse
Affiliation(s)
- Mehtap Arslantürk Eren
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara 06620, Turkey
| | - Ahmet Kaan Gündüz
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara 06620, Turkey
| |
Collapse
|
9
|
Galindo-Ferreiro A, Sanchez-Tocino H, Diez-Montero C, Belani-Raju M, García-Sanz R, Diego-Alonso M, Llorente-Gonzalez I, Perez PC, Khandekar R, Schellini S. Characteristics and Recurrence of Primary Eyelid Basal Cell Carcinoma in Central Spain. J Curr Ophthalmol 2020; 32:183-188. [PMID: 32671303 PMCID: PMC7337017 DOI: 10.4103/joco.joco_28_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 02/01/2020] [Accepted: 02/02/2020] [Indexed: 11/04/2022] Open
Abstract
Purpose: To define the incidence, characteristics, and management of eyelid basal cell carcinoma (BCC) in Central Spain. Methods: This retrospective study investigates the characteristics and the outcome of eyelid BCC from 2000 to 2016 in a central region of Spain. Data were collected on demographics, skin phenotype, location of the eyelid lesion, clinical and histological diagnosis, surgery, commitment of surgical margins, and recurrence rate. Results: Primary eyelid BCC occurred in a mean of 20.6 lesions a year or 9.4/100,000 inhabitants/year. The mean age of BCC carriers was 69.4 ± 16.2 years, with no gender difference (P = 0.479), predominantly affecting Fitzpatrick II–III skin (81.3%) (P < 0.001). The most common location was the inner canthus (154/45.7%) (P < 0.001) and type nodular (215 cases/63.8%) (P < 0.001). The surgical margins were affected in 69 (20.5%) individuals, and the recurrence rate was 5.6 (95% confidence interval, 3.2–8.3) significantly higher in affected margins (P < 0.001). The most common location for recurrence was the inner canthus (P = 0.003), and the most common histological type for recurrence was sclerosing (16.7%), then multinodular (12.5%), and infiltrating (10.4%) with no significant difference (P = 0.27). Conclusions: The frequency of occurrence of eyelid BCC is much less than the estimated crude incidence for skin tumors involving all areas of the body in the Spanish population. Eyelid BCC is more common in the seventh decade of life, with no predilection for gender. Nodular histological type is the most common. The recurrence rate is 5.6%, depending on site and affected margins, even though clear free margins also can present with recurrence.
Collapse
Affiliation(s)
| | | | | | - Minal Belani-Raju
- Department of Ophthalmology, Rio Hortega University Hospital, Valladolid, Spain
| | - Raquel García-Sanz
- Department of Ophthalmology, Rio Hortega University Hospital, Valladolid, Spain
| | - Miguel Diego-Alonso
- Department of Ophthalmology, Rio Hortega University Hospital, Valladolid, Spain
| | | | | | - Rajiv Khandekar
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Silvana Schellini
- Department of Ophthalmology, Botucatu Medical University - UNESP, São Paulo, Brazil
| |
Collapse
|