Isolated Ocular Surface Squamous Neoplasia in a Renal Transplant Recipient

Periocular and ocular surface nonmelanoma skin cancer

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.

Evaluation of the radiotherapy management of ocular surface squamous neoplasia in a high HIV prevalence setting- a retrospective review

BACKGROUND

This article evaluates a single institute's radiotherapy management of OSSN, a previously regarded as rare malignancy, for possible future development of strategies to clearly define the role of adjuvant radiotherapy in improving treatment outcomes.

MATERIALS AND METHODS

A retrospective review of 153 patients treated from January 2003 to December 2009.

RESULTS

There was no difference in OSSN prevalence by gender (male to female ratio 1.07). Of 80/153 patients tested 79 (98.8 %) were HIV positive. Most patients (62.9 %) had prior orbital exenteration. Moderately and poorly differentiated grade (82.3 %) was associated with significantly higher stage and incidence of positive regional lymph nodes. External beam therapy dose mostly used was 60Gy in 30 fractions at 200 cGy per fraction in 5 fractions per week (34.8 %). (90)Strontium therapy was given to 13.5 % (60Gy in 6 fractions at 10Gy per fraction weekly). Favourable response (complete and partial) was seen in about 80 % of patients associated with higher total doses. Regional lymph node positivity was associated with poorer outcome.

CONCLUSION

Adjuvant radiotherapy could have an important role in the management of patients presenting with locally advanced OSSN who are mostly HIV positive in developing countries. Prospective studies to evaluate the role of radiotherapy with or without chemotherapy in the management of OSSN in these settings are warranted.

Lesiones cutáneas en pacientes con trasplante renal en el Hospital Universitario San Ignacio

Introducción: Las enfermedades cutáneas son frecuentes en los pacientes trasplantados renales, por lo cual el monitoreo de la piel es necesario para realizar un diagnóstico precoz e iniciar tratamiento temprano.Objetivo: Determinar la prevalencia de las manifestaciones cutáneas en pacientes con trasplante renal. Materiales y métodos: Se evaluaron en consulta de dermatología 86 pacientes del programa de trasplante renal del Hospital Universitario San Ignacio.Resultados: Las infecciones de piel fueron las manifestaciones más prevalentes, y dentro de estas las más frecuentes fueron las micosis superficiales presentes, en un 48 % de los pacientes; seguidas por las infecciones virales, en un 20 %, y las bacterianas, en un 15 %. Se encontraron dos casos de cáncer de piel: un carcinoma basocelular y un sarcoma de Kaposi. Doce pacientes tuvieron queratosis actínicas consideradas lesiones premalignas.Conclusión: Los resultados del estudio evidencian la necesidad de realizar un examen dermatológico rutinario en los pacientes trasplantados para detectar tempranamente la presencia de lesiones cutáneas y, de esta manera, iniciar un manejo oportuno. Los hallazgos más comunes fueron las micosis superficiales.